What are the biggest and most serious mental disorders?

Fluctuating from high to low, schizophrenia and bipolar disorder are two flagship mental disorders in the world today. Around 10 per cent of the population of any developing country including Pakistan suffers either from schizophrenia or bipolar disorder where people suffer from false beliefs or delusions that cannot be corrected by logic, and exhibit symptoms of hyperactivity.

There can be a disturbance in their way of thinking. For instance, they think that so and so is after them or after their money. There can be a disturbance in their emotions or incongruous emotions where they have no control and are either laughing away or talking to themselves, which is also known as non-social speech. Sometimes they can be suffering from hallucinations and false perceptions where they visualise something or someone that others around them can’t see. All these come under schizophrenia and bipolar disorder.

What follows the two big mental disorders mentioned?

Well, the rest include depression which afflicts twice as many women as men. Then there is Obsessive Compulsive Disorder (OCD) where people keep washing their hands or repeating an activity to the point of obsession. Additionally there are widespread cases of anxiety and so on.

These disorders are not only extremely common but are also the ones most likely to be ignored as they largely pose a problem for the patient and not society at large.

Prof Syed Haroon Ahmed has been involved in treating patients of mental illness for decades. Here he shares his insights into the scope of the mental health problem in Pakistan

If they are so common then why do they go untreated for so long?

All these problems are treatable provided the patient receives help in time. But as is normally seen, when the patient’s family notices any behavioural changes in him or her they ignore them at first or think they will pass. In the cases of the acutely disturbed, the realisation comes more quickly when they see the patient’s distrust in everyone around them or when patients become physically violent. There are also cases where patients refuse to believe their parents are in fact their parents, which is called capgras syndrome.

However, for minor illness where patients are not so hostile, it may take up to one to one-and-a-half years for the family to even realise that something is wrong. Even when they do realise this they may not seek treatment immediately.

First comes the denial; they say their son or daughter is all right or that someone has cast a spell on him / her or that he / she is possessed. They drag them to faith-healers, which wastes more time. In fact, faith-healers ruin the case.

Then in many cases, after they realise that he or she is not possessed after all, they just leave them to their own devices. While when they believed that he or she was possessed, everyone was around him / her, but when the relatives realise that isn’t the case, that’s when they desert him / her.

Of course there always are exceptions. Sometimes someone in the family steps forth to take care of the disturbed person, and sometimes people also look into committing patients to a facility.

How many mental hospitals or facilities are there in Pakistan?

Not many. There are only 3,000 beds here in the shape of four mental hospitals — in Hyderabad, Lahore, Peshawar and Mansehra. Another 3,000 beds are in private practice, which include small hospitals and teaching hospitals like Civil Hospital or the Aga Khan. So since the hospitals are few, it is always better to take care and rehabilitate them at home. Or at least that’s what ends up happening.

So if a mentally ill person is being rehabilitated at home, what should the caregivers be mindful of?

It is not right to find out about someone’s diagnosis and leave him or her alone to fend for themselves. In fact, two attitudes are not good when dealing with such a person. First, he or she should not be isolated and second, one should not become overprotective. Suppose there is a very caring family member who makes the patient too dependent, then you now have a mentally unwell individual who is also effectively an invalid on your hands. It is better to recognise the problem early and seek treatment early to make the person a productive member of society.

Can you tell us what kind of mental disorders were common earlier, or was it the same as today?

Earlier, hysteria was seen as the most common mental disorder. Sigmund Freud in the 18th century associated hysteria with the uterus so he said that it was a very common problem amongst girls.

These days we say if some girl suffers from hysteria, get her married. But I say no, don’t do that please because then the family she marries into complain and say they’ve been deceived and that will make the situation worse for all concerned. Marriage, really, is no treatment for hysteria.

Of course hysteria has a new name — conversion disorder.

But now the most common mental disorder is depression, which used to be around 3-5pc in incidence but has risen dramatically these days. Some of the reasons are that there is now more awareness and far more social stressors. Everyday issues such as no electricity/water and the absence of implementation of laws gives way to frustration. Now 20pc of the population suffers from depression. And females suffer more from depression than men.

So can we say that depression is largely stress-related?

Well, different people deal with stress differently. Some get into malingering and some suffer from hysteria. While malingering they are using a symptom like a headache or tummy ache to avoid a painful situation. So it is a conscious thing which they are doing.

But hysteria is in the subconscious where the anxiety grows so much that it manifests itself in symptoms like blindness, fainting fits, loss of voice, etc.

When the stress level grows and continues, the previously mentally-ill can even have a relapse or a psychosomatic disorder like headache, stomach-ache, even heart attack or cancer; continued stress can cause physical conditions. Too much stress also sees some to opt out and go into depression. Others resort to smoking, drinking, doing drugs, etc to manage anxiety. This is almost always counterproductive.

In the modern day does electroshock therapy still have a place in the treatment of mental disorders?

Shock therapy or electro convulsive therapy (ECT) started being used around 1935, when at a mental asylum in Europe some severely schizophrenic patients who also happened to suffer from epilepsy would noticeably calm down for a few days after suffering from an epileptic fit.

It was then discovered that giving patients electric shocks brings on similar epileptic fits and helps calm them. But yes, it is no longer used as much as it used to be. Of all the patients I get, I only send one or two for ECT in a year, and only when it is a matter of life and death, as with patients who are so depressed that they become suicidal.

Do mental illnesses run in families?

The major illnesses like schizophrenia and bipolar disorder by and large are genetic, while others are environmental. So you may say that some are natural while the others, like anxiety, are nurtured. Also sometimes someone has grown up in a very healthy environment and his or her symptoms don’t show but they are nevertheless carriers. Sometimes the majority of a family is fine but some grandmother had a problem, which a grandchild inherits.

Why do people say that there is a thin line between genius and madness?

They say this because there is, in fact, a thin line separating a genius from a disturbed person. Look at it this way, a genius won’t do anything that a normal person would. They swim against the tide, think out of the box, etc.

For instance, there is the creative genius, like the artist Sadequain, who would paint obsessively. I have seen him paint. He just went on and on without taking any rest. He would be sick, would be suffering from a tooth abscess and all but would not stop. There are so many writers and painters like that.

Did you know Ted Turner, who started CNN suffers, from bipolar disorder and takes lithium salt to keep it under control?

What in your view is the definition of a completely sane and normal person?

Someone who can take care of oneself, one’s family and respect the law.

Published in Dawn, Sunday Magazine, October 12th, 2014