One in four adults experience mental illness at some point during their lifetime and one in six experience symptoms at any one time – making mental illness the largest single cause of disability in our society. Just because there are no external manifestations of several of the mental illnesses, many of us do not realize that one in four persons around us will have an illness.
Even if we do become aware of any odd or bizarre behaviour, out of context with one’s culture, how many of us do actually attribute them to a mental illness and recognize them as needing active medical intervention? How many of us know of at least one friend or family member desperately trying to guard their relatives’ mental illness? And if we do recognize them as such, how many of us advise them to consult a psychiatrist? I am sure each one of us will have an experience of stigma towards mental illness to share. I think my most striking experience in the area of mental health was the realization that an association with mental health in any capacity could be very stigmatizing and demoralizing.
One of my close relatives was a leading Psychiatrist in India. Trained almost 45 years ago in UK, he used to narrate his uphill task of getting himself accepted as a specialist, practicing psychiatry, within a general hospital setting in Hyderabad. He was initially berated and even made fun of, by the leading physicians of the day. He was allotted two or three beds in the corner of along ward in a general hospital, with hardly any support from the rest of the staff. Even in those days of exaltation reserved for ‘foreign returned doctors’, psychiatrists were called ‘paagalon ka doctor’ (meaning doctor for mad people), a trend that unfortunately continues even today.
He would hardly be invited to weddings as the hosts were secretly ashamed to be associated with a psychiatrist and be observed interacting with him, by others.
After completing my internship in Hyderabad, I went to New Delhi for my residency in Psychiatry.They used to appoint a pool of junior doctors called Junior Residents and then post them to different departments depending on the need. My own experience with stigma began here. At the allotment meeting, when I insisted for psychiatry, the allotment officer commented, ‘arey bhai, yeh to paagal khana jaana chahte hain, jaldi bhej do wahan unhe (he wants to go to the asylum, send him there quickly!).'
In 1995, I moved to Scotland (UK) for pursuing my higher studies, and arrived in Edinburgh. I had thought that things would be different here at least. This was supposed to be an enlightened part of the world- industrialized, developed and modern.However, when I went to report for my first regular hospital appointment, I was shocked to find an old, crumbling building (which surely must have seen better days) tucked away in a remote ‘glen’ (valley) and hardly commutable. The old age section, where I was posted, had a mixture of acute and chronic wards. The chronic or continuing care units were beyond description. One was greeted by dirty carpets, cigarette burns and nicotine stained wallpaper, and a characteristic smell of stale urine. When I mentioned my surprise to my Supervising Consultant, he agreed that there was institutional stigmatization, especially towards long term psychiatric care, and hence the government was trying to shutdown such long term facilities and move the patients into the community. That particular hospital was also in the process of being closed down and hence the National Health Service was not interested in maintaining it anymore.
Of course I have also worked in ultra modern, purpose built hospitals (esp. a forensic unit with single rooms and a TV set for each patient!). However, I met with the same feeling everywhere – mental illnesses are highly stigmatized, whatever the culture.
Probably the single most striking message concerning stigma was given to me by a white patient of mine. She was a young woman with a history of chronic schizophrenia,living alone, devoid of any friends or any structured activity. When I suggested that she should go out more often, meet more people and engage socially, she replied, “You don’t understand how difficult it is to live with mental illness, doctor. I have been to India and worked on a charity mission before my illness started. We are treated like Harijans by our own society!”
In India, we appear to have banished untouchability from several spheres of life. It is equally, or even more important to banish the stigma surrounding mental illness. There is a need for concerted professional and public action to achieve this goal.