Friday, January 30, 2009

WORSE THAN HIV/AIDS...notes from a concerned psychiatrist

When I was a medical student I went to the dermatology (skin) department of the university’s teaching hospital for treatment of a skin rash that had lasted for some months. As I walked in I met a nurse who knew me and we exchanged pleasantries. To save time I quickly got a house officer (junior doctor) to help me send my folder to the consultant. The same nurse came back and wanted to help out so she asked me which of the consulting room my folder was placed? Not wanting to say much I just replied the house officer was with my file… Oh! You should know that the dermatology unit also doubled as a HIV clinic and the folders of HIV positive people were handled by house officers.

This nurse hurriedly scrambled away as she looked at me like I had turned into a horrible creature. As I was leaving the clinic, I saw her again and waved but this time she ignored me. Then it dawned on me she must have mistakenly “tagged” me and was now avoiding me so she won’t get “infected”. Even though she wasn’t a close friend, that day, she definitely taught me the meaning of feeling “stigmatized”.

There is already so much talk against the stigma of HIV/AIDS so I’ll prefer to discuss a stigma that is arguably worse than that of HIV/AIDS; the stigma against the mentally ill.
Stigma actually means placing a “mark” on someone not necessarily based on their personal qualities but rather on the basis of a label which implies that this individual should be feared or classified as a member of a group that is not favoured. Not only are the affected individuals discriminated against, their loved ones also bear the brunt of the stigma… Like the saying goes; “mad man no dey shame na im people dey shame” i.e. it is the relations of the severely mentally ill that feels the brunt of the stigma.
The statement below beautifully captures the issue of stigma

“Stigma is not just the use of the wrong words or actions. Stigma is about ‘disrespect’.
It is the use of negative labels to identify a person living with mental illness. Stigma is a barrier and it discourages individuals and their families from getting the help they need due to the fear of being discriminated against. An estimated 50million Americans experience a mental disorder in any given year and only one fourth of them actually receive mental health and other services”.

People would not usually make fun of people with breast cancer or most of the other physical illnesses but that is not usually the case for mental illness. The basis of stigma associated with mental illness arises from fear and misconceptions, some of which are listed below:
Misconception #1: People with mental illness brought it upon themselves by their choices and actions.
Misconception #2: People with mental illness feel different from the rest of us.
Misconception #3: It is hard to talk to them because they are usually violent and dangerous.
Misconception #4: Mental illness can not be cured and they don’t recover.
This reminds me of an old saying that “once a mad man gets into the market square there is no more cure for his mental illness”.
The fact is, all of these assumptions are wrong.

The effect of stigma is profound and it limits the extent of contribution that the individual can make to the society. There are various forms of mental illness and the discrimination vary from one to another for example it is less for depression compared to schizophrenia however building a new and better Nigeria, amongst many other things, will also include changing our attitude towards the mentally ill. “Inclusion” rather than “exclusion” is the approach imbibed by developed nations.
Starting from the home of the common man to the assembly of policy makers there has to be a review of our attitude towards the mentally ill. Measures that can be taken to reduce the burden of stigma include

1.INFORMATION: The cure for misconception is information. Information about the true nature of mental illness, about the low frequency of dangerous behaviour among the mentally ill, and about the availability of treatment.
2.DON’T EQUATE THE INDIVIDUAL WITH THE ILLNESS: Instead of saying she’s depressed, say she has depression; don’t say he’s schizophrenic rather you should say he is a person who suffers from schizophrenia.
3.GIVE/RECEIVE SUPPORT: If you know someone who has suffered or suffers from a mental illness show love and support but if you suffer from any mental illness rather than isolate yourself surround yourself with supportive people.
4.THE GOVERNMENT COULD IMPROVE THE COMMUNITY MENTAL HEALTH SERVICES whereby treatment is taken to the community as practiced in developed nations rather than only wait for them to come to the hospitals.
5.GIVING FACE TO MENTAL ILLNESS just like it has been done for HIV/AIDS; people who suffer from mental illness should come out and talk about it. It was once impossible for people to come out and say they are HIV positive but, today, the story has changed. I believe one day it will be so for mental illness in this nation. It won’t be an easy task but it’s already happening in the western world.

True, like in HIV/AIDS the stigma cannot be completely discarded but I daresay it can be reduced. Below is a poem I believe must have been written by someone fed up with the rejection;

We are your friends, neighbours, and family
We improve and recover
We are major contributors to life
We deserve dignity and respect
Know me as a Person and not by my Mental Illness

Remember people with mental illness could live better lives…talk to a professional!

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