Today is World Mental Health Day. It is a good day to discuss something that is essential to good medical treatment, particularly mental health care, even though most doctors and patients rarely talk about it. It is a good day to discuss hope.
As a neuropsychiatrist who works in both the UK and India, I see patients with neurological and psychiatric problems. The patient stories I tell below are real, but with their names changed to protect their identity.
Dr. Prasad is a 45 year old senior doctor who has become so severely depressed after the death of his parents that he has attempted to take his own life on several occasions. His wife is struggling with the strain of caring for him.
Kamala, who came with her husband is a housewife who has been troubled for 18 years by recurrent intrusive unpleasant thoughts and images that come whenever she is trying to do housework or other important tasks. She feels compelled to repeat whatever she is doing till she can see an image of her family deity. She has a condition called obsessive compulsive disorder. After all these years, she has now sought my help because of her fear that her symptoms will ruin her daughter’s forthcoming marriage.
Shabana Bano is a great grandmother whose memory is failing because her brain is being slowly damaged by a series of little strokes. Shabana Bano had actually seen a number of doctors before me, but had not received the right diagnosis and therefore correct treatment.
Basappa, a 45 year old farmer came with a thick file of medical records. For two weeks every month he becomes abnormally cheerful, has excess energy, spends too much money. As if that isn’t bad enough the other two weeks are taken up with depression, when he feels unhappy, exhausted and has no interest in life. His is a troublesome condition with the long name of rapid cycling bipolar affective disorder. He too had seen doctor after doctor without benefit.
What is common to all these patients is that although they all have treatable conditions, by the time they came to see me they had undergone prolonged anxiety and were fearful of the future. Worst of all, they had begun to lose all hope of ever feeling well again.
And so besides listening to their history, examining and investigating them and making a diagnosis, much of my time was spent giving them hope of recovery. Not empty hope. In the weeks since I first saw them, each of these patients have started to recover, and are no longer fearful of their future.
I learned about how important hope is from my late father. a brilliant clinician of international repute. During my postgraduate training in the UK I had learned much, and been trained in the latest treatment techniques. I had believed that the most important thing that patients would want besides good treatment was the latest facts about their illness. I then returned to India for a year to work with him. It turned out to be the most important year of my training. I learned that my father too had all the facts at his fingertips, but he didn’t reel them off to every patient. He would put his hand on a patient’s shoulder, look into their eyes and say (in the patient’s mother tongue), “Don’t worry, I’ll help you”. I still remember the the relief and gratitude that would show on their faces, in their manner.
International evidence shows that the loss of hope is a powerful predictor of suicide. As I read every day of suicides in the newspaper, I know that whatever the social or financial problems that individual is said to have had, their suicides will have only occurred after they had lost all hope.
Clearly hope is what sustains patients and their relatives through periods of severe illness, and as doctors, we have a responsibility to help protect and reinforce hope wherever possible, alongside providing the best quality healthcare..
We doctors have to address ignorance and negative attitudes wherever we find it, especially within our own profession. Every doctor should be trained to recognise common mental health problems. So that even if they are not able to treat people like Shabana Bano and Basappa themselves, they can at least point them in the right direction.
I am proud of the world class mental healthcare we provide here in Bangalore. I would like to be proud of the way we as a society treat our mentally ill. So today of all days, think of people you may know who like Dr. Prasad, Shabana Bano, Kamala, Basappa are in distress or are ill. Enable them to seek help with confidence. Let us give them the hope they need and deserve.
This is the English version of an article published in the Kannada newspaper Vijaya Karnataka on 10 October 2012, authored by Dr. H.S.Aditya and Dr. H.Y Rajagopal