The term “Mental illness” has its roots long since men got civilized, its diagnoses were recognized as far back as the Greeks but it got into the spotlight until 1883 with the hands of famous German psychiatrist Emil Kraepelin (1856–1926) whose work had a major impact on modern psychiatry and its understanding of mental illnesses based on natural scientific concepts. However, even the late 19th and 20th century witnessed a major development in the studies of psychology with the discoveries of Dr. Sigmund Freud (1856-1939) who was the founding father of “psychoanalysis” which is the study of techniques to treating mental illness and also that which explains human behavior.
His proposed theories however mostly deal with human dreams, the ways of how a human mind is classified, and what are its features. But as compared to the world and time we are living in now, which has kept its promise in making advancement in technology, economics and urbanization have yet failed to cope up with the ever-increasing number of people who are becoming the victims in the hands of “mental illness” every other day without even realizing. Mental illness accounts for about 15% of the total disease condition all around the world (WHO reports). It is clinically explained as a disorder or the health condition of the ‘mind’ which affects the thinking, mood, and behavior of a person. It is at this moment that the frequency of the affected human mind, is not in synchronization with the other normalized human minds or their ways of thinking, reacting, or behaving. If spoken clinically the causes lie in the chemical activities of the brain and its signaling, however socially it gets difficult to be accepted yet today. Hence as a result the victims often fail to receive the right treatment on time. In low and middle-income countries 76%-85% of people receive no treatment at all! Mental illness comes up in various types along with its ever-weirder symptoms which often makes it difficult for the person to interact socially, or either he witnesses his helpless repetitive behavior, rapid speech, or even physical problems including hallucinations, decreased rate of sleep, and uneven palpitations accompanying manic episodes and depression. Depression, however, can be called the most common type of mental condition where a person often shows little or no interest in his or her daily activities and can have adverse syndromes if not paid any attention.
A global estimate of about 264 million people is affected with depression of which most are women. Mental illness often strikes without regard to economic class, and henceforth the strain gets too acute for the low-income people. Despite the existence of WHO’s Mental Health Action Plan (2013-2020) declared by the World Health Assembly in 2013 and the Mental Health Gap Action Program (MHGAP) which helps in achieving a healthy lifestyle and recognizes the illness and often provides technical guidance, tools, and training packages to expand help services in different countries, yet still, mental illness remains one of the biggest unmet needs in today’s world where one is two people suffers. In the USA The Patient Protection and Affordable Care Act 2010 signed by Barack Obama might seem to fill up the gap but still, a whopping 3.7 million people yet live with the conditions undiagnosed. The health systems are progressing way too slow as compared to the people suffering. As a result, the suicide rates are increasing according to the National Alliance on Mental Illness (NAMI).
Outlook onto the aspects of mental illness in India:
India, which is the second-most populous country in the world has an approximate estimation of 150 million people who are still in need of mental health care according to India’s Latest National Mental Health Survey 2015-2016 where the survey was carried out on 12 different states. However still on the tagline of ‘developing’ country India often is deeply rooted in taboos, stigmas, and myths which makes mental health conditions a real unacceptable issue. Often poor awareness about symptoms, lack of proper service and knowledge leads to this treatment gap and hence the patient suffers in silence. To compare the ratio of psychiatrists in developed countries which is 6.6% per 100,000 and the average number of mental hospital globally is 0.04% per 100,000, while there is just 0.3% psychiatrists, 0.07% psychologists and 0.07% social workers per 100,000 people in India which calls for an immediate need to pick up the pace in progression of the mental health condition.
Often the issue of mental health is badly ignored and the sufferers are called ‘lunatics’ by a society which often leads to a vicious cycle of shame, suffering, and isolation. Being called the world’s most “depressed country”, India accounts for a serious shortage of mental health workforces where less than 1% of India’s budget is devoted.
The women of India account for great sufferers when it comes to mental health as India is a patriarchic society. In some states like Rajasthan and Madhya Pradesh basically, the central and the Deccan states, women who suffer mental illness are often associated to be ‘possessed by demonic force or either seen as a bad omen and weaker vessel and who are absolutely untreatable. So, in most cases, the ‘faith healers’ are the only left-out option for society to treat the sufferers. India as already mentioned previously is a country that mostly runs all its thoughts through the perspective of ‘supernaturalism’ hence in most cases of illiteracy, the patients are often overburdened with the guilt of the disease itself.
It is and it can never become the choice of the person to act different but in most cases either they are stigmatized or made isolated with no care from even most of their close ones. ‘Even they are either sent into separate rooms and separate mental hospitals which provides poor sanitation and care and the patients are often beaten, tortured or sexually abused as there is no such policy or law which governs the happenings inside the institutions’ (Dr. Bhargavi Davar, founder of Bapu Trust NGO). Mental Hospitals in India look not less than a prison. “If we look back at the Bhore Committee report of 1946, there was a clear mention about the lack of funds in the hospitals because of which steady functioning was not that possible.
Moreover, there was a deficiency in the number of staff which could not cater to the number of patients who visited the hospitals for treatment. Apart from this, there was a stigma related to hospitalization in the form of terms for mental hospitals such as “asylum” and “pagal khana” during those times. By the mid-1960s, many people were concerned about the rising magnitude of drug abuse in India. Abuse of alcohol and cannabis was most often reported among both these groups. In addition, the abuse of other drugs such as amphetamines, pethidine, barbiturates, and tranquilizers by some was also reported. The Committee noted that special facilities to treat drug-dependent individuals were very few at that time and most were being treated in the psychiatric hospital or psychiatric department of some medical colleges. The Committee suggested several means to control drug abuse.
Heroin abuse was reported from treatment centers in 1981 for the first time, and during subsequent years, it was perceived by many experts that drug abuse, including the abuse of heroin, was on the rise. In 1985, the Narcotic Drugs and Psychotropic Substances Act was enacted and it provides the current framework for drug abuse control in India. On the basis of recommendations made by the expert committee in 1986 and the cabinet subcommittee in 1988, de-addiction centers in five central government institutes and two regional centers in two state capitals (Kolkata and Mumbai) were established” (Reported by Indian Journal of Psychiatry, NCBI, Mental Hospitals in India: Reforms for the future). The worst condition prevails in ‘The Ranchi Mansik Arogyashala’, one of the largest mental hospitals in Asia, which is a sad commentary on mental asylums in India. It lacks the proper amount of beds required besides the uncaring attitudes of the staff workers who are actually responsible for
caring. The pipes that supply water to the asylum are 56 years old and on the verge of disintegration. But the Ranchi Water Department refuses to change them unless it is paid water tax dues of Rs 1,08,000. The 3-lakh electroencephalograph (EEG) machine, an indispensable instrument used to measure patients' brain activity, has been out of order since 1978. Nobody remembers when the hospital's X-ray machine stopped working. The Ranchi mental hospital receives patients from Bihar, West Bengal, Orissa, Manipur, Mizoram, and Tripura, and almost all of them belong to the poorest of the rural poor, to families where a person suddenly loses mental balance and is locked up until the harvest season ends and there is time to drag the patient to Ranchi. The reality of the Arogyashala is dehumanizing; it produces helpless anger at the manner in which these wandering minds have been forgotten. Working for years in such an environment, some of the RMS's doctors are themselves hovering on the edge of madness, and privately admit that they are swallowing tranquilizers every day to soothe their jangled nerves.
One of the most nerve-racking of their duties is to subject inmates to Electro-Convulsive Therapy (ECT) in the asylum's "shock shop". There, inmates are held down by a cluster of attendants while a pincer-like instrument dating from the 1930s is clamped on either side of their heads. A current of 110 volts is then rammed through their skulls for half a second - a split second in which enzymes coagulate and brain cells die and the patient rears up in an involuntary convulsion.
Ultimately, Ranchi Mental Hospital doctors console themselves with the rationale that their patients are better off inside the asylum than outside - where they would probably starve to death. But that very rationale symbolizes a society that is in fact decaying.
The real heroes of the Arogyashala are the patients who have regained enough sanity to be discharged, for, alone and, unaided, they have succeeded in groping their way out of this grey world with no windows to let the light in” (reported by India Today, entitled Ranchi Mansik Arogyashala: A sad commentary on mental asylums in India).
However the government has already come up with various programs starting from 1982 ‘ The National Health Program’ with a broader aim of care, The ‘Accredited Social Health Activists (ASHA)’ by the recognized staffs from NIMHANS (National Institute of Mental Health & Neuro Sciences) accompanied by Karnataka government, along with the ‘National Mental Health Policy 2014’ which called up for the enhancement of funding and The ‘Mental Health Care Act 2017’ which targeted to empower the sufferers by safeguarding their rights and their access to treatment without discrimination.
But still, a significant change is required to fasten up the pace of health institutions and realizing proper adequate social support and care for the affected person.
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