"Fairy tales are nice." ~ Syd Barrett (6 January 1946 – 7 July 2006)
Most of us will have had some interface or experience with the inhuman practices that go on in the name of mental health treatment. We have heard of patients shackled to their beds being burnt to death, we have heard of rape and abuse, and we have heard about the horrors of addiction treatment methods. Most of us would have also experienced the stigma and the shame attached to mental health issues in a social setting. The combination of these two – a poor understanding of mental health and an ill-equipped, verging on abusive treatment environment - make a perfect recipe for tragedy. And this tragedy plays out in a million lives – both in the afflicted, and in the affected – every single day in our country.
One of the compulsions that made me step away from my life in the helping profession was my inability to understand or agree with traditional models of mental illness and its treatment. In many discussions, I have been branded an escapist, preferring to stay away rather than commit myself. Everybody is entitled to an opinion. In this post, which was originally started on the birthday of Thelonious Monk (which coincidentally is also World Mental Health Day- Google it) and completed on International Women’s Day (coincidence, purely, trust me), I share my thoughts on this topic by looking at three examples that will be familiar to most readers. This is a post that got written very, very slowly, and to allow our understanding to develop, I would invite you to read it slowly too.
|We are all searching for our center; it is just that some people need to travel far and wide before they get there.|
I must acknowledge my indebtedness to Aarathi Selvan and NVL Satish for helping me to clarify my thinking, for reading and suggesting edits to this post, and for sharing their expert understanding of the subject at hand. I am also inspired by the writing of Indu Chibber and Surabhi Surendra who tirelessly promote a better understanding of mental health through their blogs.
Are You Mentally Healthy?
The etymological root of the word “health” is shared by the words “whole” and “holy.” The World Health Organization defines it as "a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.” In the case of “mental” health, the WHO defines it as "a state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community."
Leaving aside physiological and organic disorders of the mind, which easily and universally fit into this definition, one then wonders why the understanding of mental health differs from culture to culture and across periods of time. The answer lies in the fact that the general understanding of mental health closely overlaps the “clinical definition” but adds the concept of normative behavior to it.
Take the example of cellular telephony. Fifty years ago, it was abnormal to be walking on city streets holding a metal bar to your ear and talking apparently to yourself. Today, to be surprised at people doing the same thing is considered abnormal (unless you are Mowgli, that is). Women wearing “men’s clothing” was considered abnormal in India till not too long back. Now you have men wearing women’s clothes and attending social events telecast on prime time television.
The cornerstone here is the word normal. The word comes from norm, that which is most widely accepted. The normative control that society exerts on individual behavior is important because of its contribution to roles and classes. Have roles and classes helped us as a species? Of course, yes, but have they also harmed us? We stray into altogether different and controversial territory here. Let us come back to the question of who is mentally healthy.
Take this definition - "a state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community,” – and apply it to yourself in all honesty and see if you pass muster. Each one of us is constantly in a state that would be termed poor mental health by this definition. We are constantly trying to overreach our abilities, struggling to cope with the stresses of life, constantly searching for that magic formula for productivity and fruitfulness, and more often than not, agents of conflict to ourselves and to our communities.
By definition, at least, most of human behavior today would fall in the realm of mentally unhealthy. Don’t let that get you down, because the problem really lies elsewhere.
Is Normal Natural?
Nature abhors uniformity, and it is visible not only in the diversity of species and natural conditions, but in the infinite variations that are built into the genetic code of all living beings. For structure and stability, society has always looked upon “the norm” with partiality typically reserved for firstborns. As we continue in our journey of being a civilization, we have learned to acknowledge the differences among people even if grudgingly. We have made room for gays and atheists, anticonsumerists and politicians, Shiv Sena and the social media, and we have built into our penal code the right to legal defense even for the openly and obviously guilty. Men keeping home and women wearing the pants are now considered a sign of being liberated and modern rather than of deviance. Yet at the bottom of our hearts, we are as visceral as any other species, suggesting that our women get married in their teens so that they stay out of trouble, blaming working women for broken homes, and getting all defensive about mother-in-laws or sister-in-laws intruding on our “territory.” I stray again.
Mental health needs to be seen in the perspective of this contradiction. We have tampered with the balance of nature in every way possible in the name of science, progress and modernity. We are already seeing the impact of this tampering in disrupted food chains, new and drug-resistant diseases, unpredictable climatic changes and weather patterns, and a rapidly disintegrating social fabric, but the whole impact is yet to be seen. One of the trends we are also seeing is the rising incidence of diagnoses of mental illness. What we are witnessing in all of this is really the battle between human intellect and the wisdom of natural evolution.
A disclaimer before proceeding. The advances of science are of critical importance in the evolution of our civilization and what I am saying in no way discounts the respect that that progress demands. However, emerging models of understanding psychosocial behavior need to take into consideration the natural tendency toward diversity vis-à-vis the social insistence on conformity as a measure of normalcy. Would we as a species have been any worse off without the bipolarity of Beethoven, Newton, Hemingway, or Virginia Woolf? Would we have missed Syd Barett, Charlie Parker, or Thelonious Monk? Should we have settled for medicated goo instead, say, from the minds of Van Gogh, Woody Allen or Akira Kurosawa? Or should we just sweep all of the work of so called mentally ill genii under the carpet of labels?
How to Judge Mental Illness?
It is a complex question, one which has to be tempered by reason. The question really is what the touchstone of that reason should be? Should it be protecting the patient and those around him from the harmful effects of mental illness? Should it be empowering the mentally ill to “fit in” to a society that has redefined normal every couple of decades? I do not claim to have an answer. The need to diagnose and treat the criminally insane cannot be disputed, neither can the need to provide compassionate access to learning methods to those with learning impairments. But where does one draw the line between individual uniqueness and the need for conformity?
How does one develop an understanding of mental disease that embraces the wisdom of modern medical science and the compassion and dignity that every human is entitled to? I do not claim to have the answer, but I do know that conventional models of understanding mental illness have proved to be hopelessly inadequate. Perhaps one way forward would be to examine instances and see how we can explain them in humane terms. Three facets of mental illness come to mind readily – 1) disorders attributed to family of origin issues, 2) attention deficit disorders, and 3) addiction and alcoholism.
1. Family of Origin
During my time as a clinician, the next big thing after Prozac was the concept of dysfunctional families. As I have grown in my understanding of family systems, I have come to see that there is perhaps no family that can claim to be fully functional. Similarly, manic depressive criteria can be met by almost every human being on this planet to some extent or the other. The diagnostic benchmark of when it starts becoming a disorder or adversely impacting the ability to function in a social setting is a highly subjective one. Instead of seeking to transcend the handicap of an inadequate upbringing, entire generations have chosen to act out their vitriol or melancholy, happy to blame it on their family of origin issues. For a lot of my friends, this has allowed them to carry on with their weird and self defeating ways without feeling remorse or discomfort. The mental health profession has not protested much either.
|Mom with plastic carry bag as headgear. And she is among saner ones in our family!|
How does one “label” a person with family of origin issues like shame or guilt, or rage, or self defeating cycles of relationships? How does one offer a course of “treatment?” It helps at this juncture to see that the aspect of an individual’s insight into his psycho-social framework is an evolutionary one. The task of the clinician (or family members, friends, mentors, and educators) is to help the individual see that his behaviour is caused by an impaired understanding of his developmental learning. It is especially difficult to address learning that has taken place in the early years, when there was no “adult” filter to sort out the valid learning from the invalid, but through the tools of regression, meditation, and study, it is possible to revisit the scripts that were written then, review them in the light of data available in the present, and rewrite them.
For those who are spiritually inclined, inviting the reparative forces within and around us can be of immense help. The mind and the body are amazing examples of the power of restoration, and just intending that things be restored can be the starting point of a journey of healing. Helping the individual understand the value of compassion is as critical as the “facilitator” being compassionate. Being able to see the behavior of the parents or caregivers as scripts that they, in turn, were compelled to act out, can sometimes be the catalyst that helps a person realizes that he or she has the choice to stop perpetuating the so called “dysfunction.”
2. Attention Deficit
It is my misfortune that awareness of attention deficit as a disorder was scant when I was growing up, or else I would have got to try out Ritalin and other similar drugs much earlier than I eventually did. :)
Jokes aside, somewhere in the last three decades, kids stopped being naughty, absent-minded or plain inattentive and instead got labeled as mentally ill. As a species, our brains are evolving faster and faster, and with each successive generation, the environment one is born into is evolving even faster. This places high demand on the human brain to keep pace. Two things happen as a result. Firstly, children are being born with a “neurology” that is more suited to the needs of the evolving environment than the previous generations. The second is that our existing systems and paradigms, in education, in parenting, do not have a suitable response to these changes. We do not know what to do with hyperactive students, or students who cannot focus. So in a way, (a way that is common to much of the body of knowledge that constitutes psychiatry) the problem is not with the kids, but with the world into which they are born which cannot handle their low attention spans (which, for all purposes, is really an expression of the ability to multitask more efficiently).
What we need to do is to encourage infants and toddlers to self occupy, to experience the satisfaction of completing complex tasks, and become responsible for “closing” what they have “opened.” A major factor here is modelling. If they do not see their parents or caregivers behaving in ways that are consistent with what they are being expected to follow, it is not going to work. This entails a bit of self-therapy for most parents, something that can be accomplished without much effort just by the power of love.
We also need to inspect why our teaching systems cannot accommodate the inattentive. We need to question why our education system has been corrupted into mass production facilities where individualism has no place. We need to ask why our teachers cannot teach children who are not middle-of-the-road. Maybe each one of us, as individuals, as parents, and as consumers and providers of the education industry need to rethink our contribution to this crisis. Are we creating mental illnesses to cover up for our inability to evolve humane social structures and systems? Are pharmaceutical giants helping or are they happy to see their pills fly from the shelves?
By medicating and creating compartments, we are ending up stifling the essential nature of the evolving human being. Perhaps we are even robbing our gene pool of the very things that we need to survive the future. These are difficult questions to answer with certainty. My layman status allows me to conjecture without any great consequence, but what if this line of thinking is correct? The extinction of the dinosaur was largely caused by its size. Will ours be caused by our neurological, pharmaceutical and business arrogance?
3. Addiction and Alcoholism
A similar case can be found in the case of addiction and alcoholism. By labeling it a disease and an incurable psychological handicap, millions of addicts and alcoholics have been subconsciously programmed to believe that they are compelled to act out their addictive cycle. The focus on alcohol use or drug use as the primary symptom allows many of them to resort to other self-destructive behaviors but be labeled as successful outcome by treatment professionals. The absence of a humane yet objective understanding of these behaviors causes an immense loss of human potential through needless incarceration, medication, and mistreatment.
How does one explain that addicts and alcoholics, who are often extremely intelligent, sensitive and creative people, repeatedly choose to inflict untold suffering on themselves and their loved ones? Why is it that the most successful model of treatment remains the nonmedical model of self help groups that is organized on the basis of spiritual self inspection and prayer and meditation? Instead of empowering the addict to exercise control and choice, the existing paradigms start by demolishing the myth of “choice.” At the end of the day, the individual who reclaims his life from the clutches of addiction is making a choice not to use drugs or drink or to act out his or other addictive compulsions. Yet this model – of choice, of volitional control, of reducing harm - is one that is looked down upon by traditionalists. Addicts and alcoholics who disagree with total abstinence models are branded as seriously unwell or indulging in unnecessary intellectual calisthenics, usually with a cautionary note that this is the beginning of a return to active addiction.
Being able to see addiction as an underlying quest for wholeness that the addict believes can be met through drinking or using drugs is not easy when you are in the grips of the insanity of addiction, either in yourself or in a loved one, yet that is the first and most essential step towards addressing the problem. The validity of the belief behind this quest is not as relevant as acknowledging the presence of such a belief system. Being able to see the process of addiction as effect that is simultaneously cause has to follow this insight into wholeness-emptiness. Helping the addict see the consequence of his behavior during rare moment s of clarity is the next step. Once again, creating intent to overcome this cycle of cause and effect can by itself marshal the resources that are needed to reach the now proverbial tipping point.
It helps to see that no human being would will himself to undergo the sufferings that addicts and alcoholics do. The other great misunderstanding is that the addictive process is pertinent only in the context of the particular drug, substance or behavior in question and that achieving an end to that behavior equals health. Nothing could be farther from the truth. The behavior of addiction is but a manifestation of a psycho-social or spiritual void, and failing to recognize and address that void will only result in ongoing and recurrent suffering. Appreciating the subtle interplay of causative factors and helping rewrite the script with compassion, understanding and forgiveness is the only way forward for complete health for most addictive systems.
Why are 80% of individuals seeking treatment for addiction repeat clients? Why do addiction professionals exclude the currently readmitted, the dead and those lost to follow up from their success rate computations? Why do they call it a success rate instead of failure rate when the worldwide realistic success rate is below 10%? Why are we bent upon pursuing the gold standard of conventional treatment methods when it has been documented to fail 9 times out of 10? I would ascribe it to lack of choice and clever marketing, but I am not sure I will be in the majority here. Does it bother me? Not at all. On the contrary, I feel fortunate.
Heal Your Self
Unlike other health articles that come with a disclaimer that it should not be construed as a replacement for or alternative to medical therapy, in this case I strongly suggest that we all make an effort to listen to our hearts first. The heart is never wrong. Of course, one must train to be able to distinguish what the heart says from what our insecurities or flawed belief systems say, and this can be achieved with a regular practice of, for want of a better phrase, spiritual discipline.
All of the psychosis and neurosis that we are bombarded with are nothing but the result of our alienation from our true nature. This has happened, perhaps unwittingly, in the process of modernization, urbanization and in the process of our core value being determined by our role as consumers, customers and markets.
We have forgotten that we were meant to be dewdrops of universal wonderment, songs of life and beauty, and rainbows that stitch hearts together. We have forgotten how to tap into the inner medic, the inner wise man, the inner parent. Modern medical and psychological models are of immense value in many cases, essential in many cases, but the solution for much of what is commonly understood as mental illness – our anxieties, depressions, stress disorders, and more complex phenomena like the three areas discussed here – really lies in our hands.
By adjusting our perspectives, by seeing ourselves as part of a greater organic whole and by making changes to our beliefs and lifestyles, we can experience a far more integrated sense of self that we can imagine. As we saw with normative behavior, if a sufficient number of us realize this and live accordingly, we might just have accomplished a true revolution in the field of mental health.
I would love to hear what you think and feel about this. Let us begin a dialog that will bring healing and wholeness to us as a people and as a planet.