The invisible health problem

by Lionel WIJESIRI

Sometime back I read a book called "Men are from Mars, Women are from Venus." The title alone would have you believe men are completely different from women. In certain aspects it may be true but if you talk about mental health problems, both are same.

Of course, there are few exceptions. For example, it appears that women are more likely to experience depression and men are more likely to complete a suicide attempt.

Mental Health? Throughout the history this term was often misunderstood and misinterpreted and even today it is the same. What then really is 'mental health'? According to the modern medical specialists, in simple terms, it is how we think, feel and act as we cope with life. It also helps determine how we handle stress, relate to others and make choices.

Everyone feels worried, anxious, sad or stressed sometimes. But with a mental illness, these feelings do not go away and are severe enough to interfere with your daily life. It can make it hard to meet and keep friends, hold a job or enjoy your life.

Mental illnesses are common - they affect about one in four families in Sri Lanka. This was revealed at a survey conducted by the Health Ministry Mental Health Services Division recently. Do not worry. It is not your fault if you have one. These disorders - depression, phobias, bipolar disorder, schizophrenia and many others - are real diseases that you cannot will or wish away. The good news is that common mental illnesses can be easily diagnosed and effectively treated. The key is to have the courage to seek help; seeking help is the sign of strength. Usually your family physician is a good starting point. With proper treatment, most people with a mental illness recover quickly, and the majority do not need hospital care, or have only brief admissions.

The Ministry's survey further revealed that 1% of the population is suffering from major mental illness and there is a high incidence of depression, personality disorder, alcoholism and suicidal intentions among the people. For instance, nearly 300,000 mental patients even contemplated committing suicide.

Difference

What's the difference between normal mental health and mental illness? Sometimes the answer is pretty clear. For instance, people who hear voices in their heads may have schizophrenia. And those with such grandiose ideas as becoming the President of Sri Lanka without any experience may have a form of bipolar disorder.

But more often, the distinction between mental health and mental illness isn't as clear-cut. If you're afraid of giving a speech in public, does it mean you have a disease or simply a run-of-the-mill case of nerves?

If you feel sad and discouraged, are you just experiencing a passing case of the blues, or is it full-fledged depression requiring medication? It can be either way and only a qualified physician can tell you after proper examination.

By now you will be tempted to ask, "Just what is normal mental health, anyway?"

Scientists, researchers and mental health experts have wrestled with this issue for hundreds of years, and even today the line between normal and abnormal is often blurred. This is why the fields of psychiatry and psychology are sometimes mired in controversy.What's normal is often determined by who's defining it. Normalcy is ambiguous and often tied to value judgments particular to a certain culture or society. And even within cultures, concepts of normal mental health may evolve over time if societal values or expectations change.

One thing that makes it so difficult to distinguish normal mental health and abnormal mental health is that there's no easy test to show if something's wrong. There's no blood test for obsessive-compulsive disorder, no ultrasound for depression and no X-ray for bipolar disorder, for example. That's not to say mental disorders aren't biologically based. Most mental health experts do believe that some mental disorders are linked to chemical changes within the brain, and they're beginning to map these changes visually using imaging studies.But for now, there's no physiological diagnostic test for mental illness.

Signs

Mental health physicians define mental disorders by signs, symptoms and functional impairments. Signs are what an observer can document, such as agitation or rapid breathing. Symptoms are subjective, or what you feel, such as euphoria or hopelessness. Functional impairment is the inability to perform certain routine or basic daily tasks, such as bathing or going to work.

In mental illness, there are few common signs and symptoms: Strange behaviours (such as repeated hand washing), feelings (such as continued sadness), thoughts (such as delusions that the television is controlling your mind), physiological responses (such as sweating), marked personality change, inability to cope with problems and daily activities, strange or grandiose ideas, excessive anxieties, prolonged depression and apathy, marked changes in eating or sleeping patterns., abuse of alcohol or drugs and excessive anger, hostility, or violent behaviour.

The most important question comes into your mind now. "What can I do to avoid such problems?" First, notice your emotions and reactions and try to understand them. Learning how to sort out the causes of sadness, frustration and anger in your life can help you better to manage your emotional health.

Your body responds to stress by making stress hormones. These hormones help your body respond to situations of extreme need. But when your body makes too many of these hormones for a long period of time, the hormones wear down your body - and your emotions. People who are under stress a lot are often emotional, anxious, irritable and even depressed.

If you are emotionally healthy, you are in control of your thoughts, feelings and behaviours. You feel good about yourself and have good relationships. You can keep problems in perspective.

It's important to remember that people who have good emotional health sometimes have emotional problems or mental illness. Mental illness often has a physical cause, such as a chemical imbalance in the brain.

Stress and problems with family, work or school can sometimes trigger mental illness or make it worse. However, people who are emotionally healthy have learned ways to cope with stress and problems.

They know when they need to seek help from their doctor or a counsellor.

If possible, try to change the situation that is causing your stress.Relaxation methods, such as deep breathing and meditation, and exercise are also useful ways to cope with stress.

Myths

Tragically, people with mental illness are frequently stigmatized by others who think it's an uncommon condition. They forget the fact that, mental illness can happen to anybody including them.Don't label people with words like "crazy, wacko or loony" or define them by their diagnosis. Instead of saying someone is "a schizophrenic," you should say he or she "has schizophrenia." Without saying "a schizophrenic person," say "a person with schizophrenia." This is called "people-first" language, and it's important to make a distinction between the person and the illness.

Treat people with mental illnesses with respect and dignity, just as you would anybody else.

Respect the rights of people with mental illnesses and don't discriminate against them when it comes to housing, employment, or education. Like other people with disabilities, people with mental health problems are protected under Constitution of our country.

Arm yourself with the facts and then use your knowledge to educate others and reach out to those around you with mental illness.Understanding and support are powerful, and they can make a real difference in the life of a person who needs them.

(Grateful thanks to Dr. Pete M. Johnson M.D., Consultant Psychiatrist, who (in spite of his busy work schedule) spared enough time to give me valuable advice for this article. He is an expert in the pharmacologic treatment of mood disorders, including depression and bipolar disorder)