The societal consequences of mental illnesses are grave. It costs too much to the individual and his family. I am not talking about stigma and lack of treatment. Lack of acceptance and lack of misunderstanding are equally contributing to the burden.
Mr Rajat was working as ground staff in an airline. He was 55 years old. He had extreme stress at the workplace. It was so much that he did not want to go to work daily. He would avoid it. It was going on for years and he could not bear it. There were few years left for retirement and he decided to take early retirement. However, he had no plan as to how he would spend his retirement time; he just wanted to get rid of his stressful job. When his family member brought him to me, I could see all the signs and symptoms of depression. After much convincing, Mr Rajat reluctantly started medicine. As I had promised him that after completing three months’ treatment, if he still felt like taking retirement I would support him. With this assurance, he started treatment. He showed improvement over a few months; he could sustain the pressure of work. Then he decided against taking early retirement. I have a few patients with similar issues. Unfortunately, some depression patients had already either resigned or taken voluntary retirement; still they did not feel better, and then they approached me for treatment. Sadly, they lost their jobs. In these examples, it is sheer misunderstanding that their suffering was due to the situation; on the contrary, it was due to the mental illness which might have been precipitated by the stressful environment.
Mental illness affects relationships; it strains the bond between individuals. Reshma, a 23-year-old married woman, felt that her husband was doing something to her. She would complain about it to her mother and sister. Her mother brought her back to her place. All of them filed court cases and police cases against the husband. After some time, Reshma become more suspicious. She became aggressive and violent towards her mother and sister. She wandered away from home. Her sister had immense trouble finding her. Somehow, her sister managed to get Reshma admitted in a mental health care facility. Her illness was paranoid psychosis, which made her suspect all her family members including her husband. After her mother and sister were counselled, Reshna’s husband was called but he was reluctant to come and meet the treating doctors and her. After persuading, he agreed. The whole family was counselled. Reshma became better after a few months and withdrew all her cases against her husband. It has been more than five years now, and she is better. She has a three-year-old son and the the family is happy. A marriage has been saved.
Some patients like Reshma, where the family members understood the illness, have taken steps towards treatment. But paranoia can be deceiving. For example, if a married woman complains that her husband troubles her, doesn’t want her to progress in life, and that he demeans and ridicules her — all these complaints are possible. Her family will obviously take her side. And then the fights start. There are allegations and counter-allegations. The relationship is post-mortemed in a heinous manner. Sometimes, after all this drama, the family realises that the suspicious and paranoid behaviour is still present and only the target has changed. It is wise to take time and do things carefully in such situations. It is better to end a relationship with courtesy than a bitter fight.
In such situations, as a professionals we need to carefully find out whether the complaints could be valid. Whether there is a lack of judgment, whether the complaints are based on minute details or without details. One Mrs Nair alleged that her husband was having an affair. But she did not have any evidence. She would say that her husband is smart and erased evidence. Sometimes the allegations were that her husband was meeting his love under the pretext of working late. She would call the office and find out that he was in the office. But she would say that he “managed” the office boys, sneaked out and returned to the office. But there was no evidence of all this. If this persists over time, it might become bizarre, or it could become difficult for the other person to stay with someone exhibiting such behaviour. However, treatment can bring about magic in behaviour and save the relationship.
Roma, a middle-aged woman, has bipolar mood disorder. During mania she would allege that her husband does not care for her, does not love her and does not have intimate relations with her. She would tell all this to her parents and say she wants a divorce. Initially parents thought she was right, and they would blame her husband. The family had a huge fight. However, when Roma was treated for her illness all her allegations vanished. In her second and third episode her parents believed her story again. But the psychiatrist explained that this could happen with any woman. The parents came to understand her illness, and treated her well during such episodes. She would be very nice, loving and caring after the phase of mania would pass.
Sometimes, it becomes difficult to understand mental illness as it has symptoms of human behaviour which are possible and not bizarre. Then it leads to a lot social or legal consequences. The illness remains untreated, and leads to further burden in the family and relationships. I have witnessed many families who were broken, shattered and ended in misery.
It is better to accept mental illness and its treatment, to avoid unnecessary social consequences. Mental illness is what mental illness does ... personal, familial and social deterioration.
Dr Shailesh Umate is a consultant psychiatrist, sexologist and addiction specialist, whose mission is spreading awareness about mental health and well-being
