Do you think I'm losing my mind, doctor? I am often asked this question by patients during the first consultation at the clinic. Most certainly not, is the emphatic answer, explaining that chemical imbalance is the likely cause (or as Munnabhai would say, chemical locha). After emphasizing that depression and anxiety are like having any other illness such as diabetes or hypertension, and are eminently treatable, we discuss treatment options. The initial fear almost always changes into a sense of relief. Individuals realize that they are not alone, that millions of people globally deal with such problems every day, recover well, and continue to lead productive and often amazing lives.
The good news is that we're in the midst of a gradual but steady global shift in the attitude of individuals and society towards mental health and psychological well-being. This is a positive change from even 20 years ago, when lack of awareness abounded. Myths were widely prevalent, including those of 'black magic', 'emotional weakness', 'exercising willpower' etc, though some myths still persist such as those regarding anti-depressant addiction. People from all walks of life—students, professionals, businessmen, housewives etc—seek help from health professionals in the field more readily today. Often, it is the first time they have ever talked to anyone about what they are going through. Even in India, people often carry an impressive amount of printed information on the subject on their visit to the doctor. A bunch of well thought out questions with a readiness to participate in a discussion on treatment options is common, an encouraging trend indeed. Treatments available today in India are far better and safer than ever before, and on a par with the best in the world. Fortunately, the majority of individuals respond well to timely and appropriate treatment.
Recent developments in the field make it an exciting time for psychiatry, with great promise in understanding the fundamental causes of psychiatric illness and in developing increasingly effective and safe treatments. Sophisticated brain imaging techniques, advanced psychological tests and psychotherapies/counselling techniques, newer and safer medications and state-of-the art treatments like rTMS (Repetitive Transcranial Magnetic Stimulation) have enhanced the treatment outcome immensely. The future of psychiatry holds many promises for early diagnosis and better treatments: newer brain imaging techniques, genetics and stem cell research, and potential treatment options, including gene therapy and stem cell therapy (Hendler T, 2012; Noori-Daloii MR, 2012; Margolis et al, 2011).
The bad news is that we are at a much higher risk for psychiatric illness today than our ancestors, triggered by modern-day stress, competitiveness, high ambitions, wanting too much too quickly etc.
The World Health Organization (WHO) has cited depression as the leading cause of disability and the third leading cause of disease burden worldwide (World Health Organization, 2008; Marcus M et al, WHO paper on depression, 2012). It also predicts that by 2030, depression will be the leading cause of disease burden globally (WHO, 2008). Not surprising, as 15-20% of the world's population, irrespective of class, culture or nationality, experiences clinical 'major depression' at some point in their lives—this is increasingly true in India too. Relatives of patients often ask agonizingly: "Doctor, he has everything—there are no stressors—everything is fine at home, he has a great job, lovely kids, everything is fine with us: then how can HE be depressed?" One then explains that it is no one's fault, as it is caused by a combination of biological, psychological and social factors. Genetics play a major role, which means that having a family member with mental illness puts one at a higher risk (just like in heart disease or diabetes). Brain chemicals such as serotonin, norepinephrine, dopamine, etc are involved. Life events merely act as triggers, they do not cause mental illness. Technology, although a boon in many ways, can add to the statistics: internet addiction, cellphone-related insomnia, and addiction to networking sites causing or worsening psychological problems.
Furthermore, costs of not treating psychiatric illness are enormous, and include costs of lost productivity (employee absence, decreased focus), associated medical illnesses (untreated major depression can trigger major illnesses such as diabetes, high blood pressure, high cholesterol, heart disease etc) and even lost lives (rising rates of student suicides, increased accident rate among depressed individuals) (Greenberg et al, 2005; Iosifescu et al, 2004; Leon GF, 2003; Charlson et al, 2011).
The greater task at hand is for mental health professionals to help destigmatize mental illness and help create facilities for prompt and appropriate treatment of the mentally ill. We need many more mental health professionals, including psychiatrists (we currently have one psychiatrist available for every 4,00,000 people in India), psychologists, psychiatric nurses and social workers (Bruckner et al, Bulletin of the World Health Organization, 2011). We also need more space, better research facilities, and most importantly, a greater awareness so that we can recognize and treat psychiatric illnesses early and appropriately, and perhaps reduce suffering and economic costs to the individual, families and society.
At a societal level, although a lot has changed, giving us reason for optimism, a lot more remains to be done, including educating ourselves regarding psychiatric illness, spreading awareness, helping individuals get appropriate treatment and doing away with stigma. In the West, people speak much more openly about their psychiatric illness than in our country. Celebrities are at the forefront, with many having written books on their first-hand experience with psychiatric illness and some speaking openly on talk shows. A similar trend in our country could possibly do wonders for the mental health of the general population. As Rosalynn Carter said in her book Within Our Reach: Ending the Mental Health Crisis, erasing the stigma of mental illnesses is a step towards curing them (Rosalynn Carter, 2010).
Psychiatric illness is like any other medical illness, and taking care of it in a timely and appropriate manner can save one's health, and possibly one's life. The focus now is not just on treating the illness, but also on helping the individual attain a state of 'complete well-being' and on preventing psychiatric illness in the population. For me, it has been a challenging and a very satisfying journey to make a difference in so many lives, as it has for my colleagues. To see individuals get better, and resume leading productive and happy lives is indeed the most gratifying part of our profession. I hope that this column will be a step towards increasing awareness regarding mental health, and enhancing the quality of people's lives.
(The author is a consultant psychiatrist at Jaslok Hospital)