By Siddhartha Bhasker
In India, once you are labelled as mentally ill or ‘paagal’, people often react to you in a judgmental manner. You will be gossiped about, made fun of, and will likely live like a social outcast. Is it the same all around the world? Or are some people trying to find reasonable solutions to this issue?
The unique stigma associated with Schizophrenia
Schizophrenia is one such mental illness that is widely stigmatized and misunderstood. A schizophrenic individual finds it difficult to distinguish between the real and the imaginary. Brought to mainstream discussion by the broadly acclaimed movie on American mathematician and game theorist John Nash, ‘A beautiful mind’, schizophrenia affects a large population of the world. In India, eight to ten million people are estimated to be living with schizophrenia.
There are two methods to deal with schizophrenia. The first, is the medical way prescribed by psychiatrists. The patient is prescribed a dose of medicines like Risdone-Plus to treat the illness. From a scientific point of view these medicines are not a cure. Instead they help in reducing the symptoms like auditory and visual hallucinations. But they have their own side effects, like making the patient feel drowsy or leading to obesity.
‘Accepting Voices’: an emerging voice of reason from Europe
The other new approach promoted by a group of practitioners in Europe is that of reasoning with your voices. This is applicable for people who hear voices in their mind, a prominent symptom of schizophrenia. This school believes that the voices heard are related to trauma the patient has gone through in the past. The trauma could be related to family disputes, sexual abuse, emotional abuse and so on. The treatment relies on accepting these voices as a part of the patient’s existence and trying to get to the source of them, which may be the patient’s experience from the past. In this manner, a continuous conversation with the voices is facilitated, thereby helping manage them and enabling long-term recovery.
This approach has been promoted by psychiatrists Marius Romme and Sandra Escher in their book ‘Accepting Voices’. The book has been translated into several languages and has helped many patients understand and recover from their auditory hallucinations. No translation of this book is available in any Indian languages as yet. Supporters of this school of thought have travelled to different parts of the world to make this approach available to patients.
Patients in Europe, America, Japan and Australia have shown positive results. In the book ‘Living with Voices: 50 stories of Recovery’ by Marius Romme, there are stories of people whose lives changed once they started reasoning and conversing with their voices. They have started accepting these voices and are trying to find its link to their past. In some case they have even been able to totally get rid of the voices in their heads.
Most of these movements have started with the formation of ‘voice-hearing groups’. A voice-hearing group is a place where voice-hearers can come together and discuss their experiences with each other. Patients in voice-hearing groups have given positive reviews about such meetings, as they are in the presence of other people who undergo the same difficulties as them. They can speak freely, as opposed to being judged by among others who can relate to their problems. They can help each other find logical solutions to their issues.
India greatly needs such a movement to help people come together and deal with schizophrenia as an engaged community. This in its own right would be a step towards inclusive treatment, as evidenced by results from all over the world.
To be able to use the above approach, one also needs the help of trained psychiatrists and counselors. They should be well-versed in this approach and be willing to listen to their patients. The current dependence on neuroleptic and antipsychotic medicines in India is not the only way in which one can get rid of the mental illness. Currently, this is sole approach available in India as well as in most parts of the world. Even though these medicines are useful, they are not a permanent cure. The patients will still continue to have auditory and visual hallucinations.
In his Pulitzer Prize nominated book, ‘Anatomy of an epidemic: Magic bullets, psychiatric drugs and the astonishing rise of mental illness in America’, writer Robert Whitaker has skillfully brought out the problem. He clearly displays scientific data which show that the long term effects of these medicines are more harmful than good. Sometimes even a placebo works better than these medicines. The spreading use of these medicines is related to the business side of medicine rather than the treatment. He also extols the use of the ‘Accepting voices approach’, saying that these alternative treatments could be the way forward.
For a long time, an area called Western Lapland in Finland had one of the highest rates of schizophrenia in Europe. But they adopted a model called Open Dialogue technique, where instead of putting a patient on medicines, they formed a team of 3-4 trained therapists. The team visited the family of the patients and had multiple interactive sessions with them. Medicines are prescribed only when absolutely necessary. This method of using open dialogue as a means of treatment has been highly successful. As a result, the number of schizophrenic and psychotic patients in Western Lapland has considerably reduced over the last couple of decades.
India too must urgently try the Accepting Voices and the Open Dialogue approach. Voice-hearing groups should be formed across the country to encourage patients to get in touch with each other, and talk about the voices in their heads. Psychiatrists should be aware of this approach and should not merely keep prescribing medicines to every patient who visits them. A more holistic approach is the need of the hour, as the number of mentally ill people is on the rise. Even though, as per a WHO report, India is one of the best countries to live for schizophrenics, there is much scope for improvement in how mental illness is approach in the workplace and other aspects of the community.
Siddhartha Bhasker is Assistant Professor of Economics at Jindal Global Business School.
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