Clarifying misconceptions about mental disorders (1)

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3 years ago

Feedback interactions from several readers clearly indicate the need to attempt some generic explanations about the concept of mental disorders and how they are managed. First, all our thinking, behaviour, mood, personality and movement are all functions of our brain. These functions are controlled by the levels of certain chemicals in our brain. When there are abnormal levels of these chemicals, abnormal patterns of thinking, mood changes and behavior – thus manifesting as symptoms of mental ill health would occur. These for example, would explain why you take certain drugs (chemicals) like cannabis or cocaine and it distorts thinking, mood and behavior…by altering the chemicals in the brain.

These changes in the levels of brain chemicals may occur as a result of 3 categories of risk factors:

Biological: Such as family history, or our gender may place us at risk for certain conditions. For example, females are more likely to be depressed than men; whereas men are more likely to be using psychoactive drugs.

Psychological: Our childhood experiences may protect us or place us at risk of developing mental health problems in later life. Someone who suffered child abuse (physical, sexual or emotional) for instance, is at higher risk of developing depression and substance abuse as well as having anger management issues as an adult, than someone who had a happier childhood. Our personality outlook to life may also protect or make us vulnerable to developing these disorders.

Social: Life stressors such as divorce, domestic violence, alcohol and drug abuse, unemployment, natural or man-made disasters, loss of loved ones, exposure to traumatic life events, or taking psychoactive drugs can predispose one towards developing mental disorders.

I should also clarify that these factors above are only risk factors. Not everyone who has these risk factors will develop a mental health problem. For example, let’s assume that both of my parents suffered from hypertension. What that means is that I am at an increased risk for developing hypertension. But I may live up to a 100 years and never develop hypertension. Same scenario applies for diabetes. This is exactly the situation with respect to mental disorders. Not everyone with a family history will develop it.

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Not everyone who is exposed to trauma or domestic violence will develop it. But they are at higher risk than others. The converse is also true: some individuals with no prior family history of hypertension, diabetes or mental disorders will go on to develop these disorders at some point in their life time. So there is no reliable predictor or immunity from developing hypertension or from developing a mental disorder.

There are also two concepts that are helpful to keep in view: vulnerability and resilience. It is like having two balls made of glass and plastic respectively. If you throw them forcefully against a wall, the glass ball will shatter into pieces (vulnerability) whereas, the plastic ball will bounce back, none the worse for the impact (resilience). Thus part of what we aim to do with psychotherapy is to build resilience and overcome vulnerability….as every human being at some stage in our life will necessarily come across challenges and adversity (walls). Even if your father is the President of the country or the richest man in the world; it does not confer on you, any protection whatsoever, from a bad marriage for example; or from disappointments in business or career.

Can these conditions be effectively treated in hospitals?

The answer is most definitely yes. We utilise a combination of bio-psycho-social approach to treatment, as briefly explained here: biological; use of medications to correct chemical imbalance, improve mood, reduce anxiety etc.

Psychological: May require psychotherapy, which aims to strengthen resilience and overcome vulnerability.

Social: May require change of school for example if school bullying is a problem; or couple or family meetings, use of exercise etc.

Do people get completely cured?

All these conditions may be one off episode and with treatment; they recover and never have another episode again. However, some individuals may have recurrent episodes that require long term control and management of the conditions with the use of drugs and regular follow up appointments. This is no different from what happens in other chronic medical conditions such as diabetes or hypertension. We don’t cure hypertension, but we control and manage the blood pressure with medications and they come to hospital from time to time for follow up appointments. Ditto for diabetes, which is not cured but with good dietary control, use of medications, as well as regular follow up clinic appointments. Similarly, in chronic forms of mental disorders, they need to use medications to restore and maintain proper chemical balance and they are absolutely fine; and function to their full potential without any hindrance…just like someone with well controlled hypertension or diabetes.