CLARIFYING THE CONFUSION ABOUT PSYCHIATRIC ILLNESS (www.drmjthomas.com)
What is psychiatric illness?
If you ask a hundred people around you whether they are sad or tense, twenty of them will say ‘yes ‘. If you go further to ask why they are unhappy or tense, fifteen of them will give the reason and attribute the cause of their misery to an event that has happened or to an event that could trouble them in the future. If you were to attend a funeral, you would find people crying to express their sadness at their loss. If you were to visit these people three months later, you would find them back to their normal lives. Human beings have an inherent capability to cope with stress. Hence, given a little time, they cope by talking to significant others in their society and returning to normal life. This behaviour after a stressful event and the return to normalcy by coping with the stress is called ‘Post-traumatic stress disorder’ (PTSD). Normally, professional intervention is not required for them unless it leads to dangerous situations like an attempt to commit suicide or homicide. However, people confuse these stressful reactions with other primary psychiatric illnesses. The lesson to learn here is that stressful events are inevitable in life, and most people can cope with them using the available resources in their society.
What about the five others? If you ask them what caused their sadness or tension, they often find it difficult to determine the cause and tend to relate it to random, stressful events in their life that may seem acceptable to others. They are the people who suffer from ‘Primary’ psychiatric illnesses. Hence, you can safely assume that one out of twenty people in society may experience some form of psychiatric illness sometime in their life, and they suffer for a longer time than those who go through inevitable life stresses. Very often, they have no answer as to why they suffer emotionally and are not able to get out of the emotional turmoil despite all their efforts.
Why does this happen? Psychiatric illnesses are primarily inherited. What the genes change is the ‘manner’ in which you think. ‘What’ you think depends on your culture, society, education, etc. and is different from ‘How’ you think. All of us are in control of our thoughts if we are not ill. For example, if we get an inappropriate thought, we will analyse its rationality, decide it is ‘inappropriate’ and discard it immediately. To explain in understandable terms: we have a ‘Switch’ to switch off unwanted thoughts and continue to think only what we want to think. This is how we usually think. However, when someone gets a psychiatric illness, this ‘switch’ disappears and the person cannot switch off the thoughts that come to their mind, irrespective of whether they are ‘appropriate’ or ‘inappropriate’. The abnormal genes interfere with the brain’s functioning by altering the brain chemicals. These changes in the brain make the ‘switch’ dysfunctional. Hence, a thought that comes to the foreground in the brain cannot be switched off. They must go on and on until they fade off naturally. Often, these thoughts disturb the individual. It can be frightening, and because they come repeatedly, without an end, the person can get extremely sad, sometimes resulting in suicide.
Why do these peculiar thoughts come to your mind? From anywhere around five years of your life and even earlier, the brain stores all your experiences, like Google stores all that you do. Normally, only a fraction of these stored experiences is brought to the foreground at any given time. However, when the ‘switch’ becomes dysfunctional, these stored experiences come to the foreground at random and often without logic, just as you find your computer behaving erratically while it gets infected with a virus.
What kind of thoughts come to the foreground when the ‘switch’ becomes dysfunctional? The brain stores every kind of experience in life. We call them memories. We also associate an emotion with these memories. We assign a symbolic language to these memories. Hence, when the switch becomes dysfunctional, these thoughts come to the foreground at random, sometimes illogical, in the form of a language, associated with an emotion and sometimes experienced as a voice.
How does one experience these changes? Firstly, it is important to recognise that there are many forms of psychiatric illnesses. Some illnesses are ‘Episodic.’ Others are ‘Continuous.’ Some illnesses show significant expression of mood along with related changes in thoughts. Yet others can switch between an excessively depressed mood and to excessively happy mood with free intervals of normal mood in between. In some other illnesses, people experience certain ‘voices’ of others as they would hear them from a mobile phone. Yet others become ‘suspicious’ and get convinced about their illogical experiences. There are also many other forms of expression in psychiatric illnesses, and only the most common expressions are explained here.
How do you then treat the psychiatric illness? One must understand that there is no ‘cure’ for psychiatric illness till now. You can ‘control’ psychiatric illness like you control fever with paracetamol or diabetes with antidiabetic medicines. These medicines are to suppress symptoms if they exist. If there is a mood change, one takes medicines to normalise the mood; if one hears voices, they take medicines to suppress them and so on.
Do you take medicines at the same dose continuously? No. Treating psychiatric illness is highly technical and needs-based. Hence, you need to consult a psychiatrist to decide about your medicines. The general principle is to use medicines appropriately, which means the lowest effective dose of medicines to control the illness without side effects when needed.
Is psychiatric illness limited only to your brain? Does it affect other organs? Psychiatric illness affects every organ in the body, directly or indirectly. An explanation of how it affects other organs is available in the other sections. An explanation of how to control the consequences of psychiatric illness is also available in the other sections.
Does this explanation fit with all psychiatric illnesses? No. Children’s psychiatric illnesses are very different. An addiction to alcohol and an addiction to drugs need a different explanation. Personality disorders are different. This explanation is to provide an understanding of the common forms of psychiatric illnesses only.
BEHAVIOURAL CHANGES IN PSYCHIATRIC ILLNESS (www.drmjthomas.com)
Will changes in mind and body influence your behaviour?
If you observe people with a physical disability, you will notice some of them will adapt and cope with the disability well and become comfortable, while others become frustrated and infuriated. If one gets paralysis of the right arm, he may learn to write with the left or become frustrated and angry, resulting in dependency on others. Every person who faces some form of distress will have unique reactions to it, affecting their mind and body and will have changed behaviour. Doctors, family, friends, peers, and members of his society constantly observe these changes to draw different conclusions. If this behaviour is inappropriate to their culture, the person gets ‘branded.’ In the case of psychiatric illness, the person has an abnormality in their thought process along with resultant bodily changes, producing behavioural changes. If these behaviours are inappropriate and are noticed early, he gets branded. However, not all behavioural changes are due to psychiatric illnesses. It can also be due to a physical illness or a conscious, selfish, manipulative, intentional behaviour. This makes it difficult for observers to conclude the origin of the altered behaviour. This is the reason psychiatrists observe verbal and non-verbal communication before they conclude their diagnosis.
These changes in behaviour are important in many ways for the patient with psychiatric illness.
- Firstly, they can get branded and excluded from society, resulting in poor peer relationships and an inability to be independent. Many such people can become dependent on others for life, unproductive and discarded by their caregivers. Some of them can end their life.
- Secondly, despite the treatment of psychiatric illness, these behaviours may persist for a long time since they have become a habit. Hence, it is important to correct them.
- Thirdly, the caregivers may doubt the intention of these behaviours, suspect these behaviours are intentional and punish the patient.
HOW DO CAREGIVERS DEAL WITH PERSONS WITH PSYCHIATRIC ILLNESS? (www.drmjthomas.com)
What should caregivers do when they deal with their loved ones?
If you have a person with a psychiatric illness in your family or amongst your friends, you need to take care of them. Unlike caring for patients with cancer or paralysis, caring for psychiatrically ill persons can be testing for caregivers. In most circumstances, caregivers do not understand what the patient expresses during the illness. At the same time, the patient does not understand the caregiver either. The logic that the patient uses to communicate his feelings and observations can be quite different from the caregiver’s logic. Patients describe events around them based on their illogical thoughts while they are ill, while the caregiver understands them based on the real situation on the ground. There can be a gross disparity in understanding of the same subject between these two individuals. Very often, caregivers aggressively correct patients from their thoughts and behaviours. Consider you have severe abdominal pain, and then you may not go to work, eat well, take a bath or do any serious productive work. You may also become restless and irritable. If the caregiver does not recognise his pain and forces him to do the chores, he reacts angrily. As time goes by, the abdominal pain reduces, and he conducts his daily chores without force. Later, when he is completely pain-free, he takes care of his work as earlier. The stages of recovery in psychiatric illnesses are similar. As the patient improves, he can conduct daily chores spontaneously. However, his thoughts remain illogical. It will be difficult to correct him from these thoughts since his logic is still irrational. Daily chores get corrected first, and logical thinking later. Patients who have become ill recently recover in this order. Those with longstanding illnesses, however, learn certain inappropriate ‘habits’ during the illness and do not change their habits easily. Caregivers need to think like the patient. They must encourage the ill person to return to normal functioning, but not force. At the same time, inappropriate habits in patients with longstanding illnesses need to be forcefully corrected.
The reasoning described above applies to most psychiatric illnesses. But there are exceptions. People with problems of addiction are usually managed with a punishment and reward paradigm. For inappropriate behaviour, some form of punishment or denial of reward is organised, while appropriate behaviour leads to rewards. These are usually conducted in professional rehabilitation centres. Certain people have personality types that are different from others. There are attention seekers. When they become ill, they exaggerate the symptoms. If they receive continuous sympathetic attention from caregivers, they perpetuate the symptoms and gain from it. There are also very stubborn, obsessive people. They may require medicines to control their stubbornness when they become ill. Some people are manipulative and selfish. They can manipulate the caregivers and split them apart during their illness. The caregivers of these patients need to always be careful to be united in their actions. https://www.youtube.com/watch?v=r93avRTi8mw This video gives you substantial information on how to deal with psychiatrically ill people, explained by a young person who has gone through it all.
QUICK REFERENCE TO HELP A VERY ILL PERSON (The information below gives some ways to help people who show exceedingly difficult behaviour)
Unfriendly and suspicious patients
- Do not argue with the person about their ideas or thoughts, or try to prove them wrong.
- Change to a concrete topic that is not related to suspicions.
- Be friendly and accepting. Do not get angry with the person.
- Do not whisper or talk secretly when the person is in the same room or nearby.
- Do not talk or do things behind the person’s back.
Restless, constantly walking back and forth or overly excited.
- Do not try to hold on or restrict the person.
- Talk to him and get his attention.
- Firmly but without anger, ask him to come to you and do what you say.
- Tell him his behaviour is disturbing you and you would like him to stop.
Avoids people and will not let others come near
- Approach the person slowly and friendly. Stop in front beyond his reach to avoid aggression and greet him in the usual way.
- Talk to him about things you both can see and discuss. For example: Is that chair comfortable?
- If he answers, continue with small talk.
- If he stops talking, try again to get him to answer. If he becomes restless, thank him and leave.
- Repeat this small talk many times until he allows you to come near and talk to you about how he is feeling.
- Have the family members continue their activities near the person so that they can watch him.
- Family members should continue to talk to the person even if he does not answer.
Aggressive behaviour and suddenly strikes out
- Stay calm and do not show that you are frightened, but quickly go for help.
- Speak in a firm, loud and commanding voice: “I would like you to stop this behaviour”.
- Remember that the person does not always know what he is saying or doing.
- Give the person an activity which requires them to use their energy and get distracted.
- Do not let him use objects that are sharp or that can be used as a club.
- Instruct other persons not to argue with the person and to stay away until he calms down.
- Talk to him about his behaviour when the person is calm. Make suggestions about other activities he can do that will help the anger disappear.
How to prepare for a psychiatric consultation with Dr Thomas? (A patient-based approach is followed for consultation.)
| Personality disorders -Not treated ( exceptional cases with obsessive personality & borderline personality with mood fluctuations are seen). Addictions- Not seen and treated |
| Affective disorders & Schizophrenia – Seen and treated generally with medicines |
| Psychiatric Factors in Dementia – Treated for their psychiatric symptoms with medicines and referred to geriatricians for other problems |
| Psychiatric factors in marriage – Evaluated to see if it is due to a psychiatric problem, and if so, treated with medicines and referred for marriage counselling |
| Psychiatric factors in medical illness – Treated for psychiatric symptoms and referred to physicians for medical problems |
Process of consultation
- Analysis of the pattern of thinking, feeling and behaviour of the patient from information gathered from the patient and the informant, to make a diagnosis.
- Examination of previous psychiatric and medical treatments and their results. (Bring all previous treatment records to avoid repeat investigations)
- Explanation of the treatment plan to the patient. (Start treatment/leave it alone/refer back to treating doctor/refer to a local doctor for patients from distant places)
- Informed and responsible acceptance of treatment by the patient
- Providing the prescription and review date