Monday, March 2, 2009

I'll be talking about what could cause mental illness and coping with loved ones with mental illness I hope you enjoy and learn something.

Demystifying mental illness...notes from a concerned psychiatrist

Seun was only 13years old when it first happened. She had returned home from school and headed straight for her mom’s provisions shop which she found locked. Thinking this was rather unusual, she headed for home which was close by. On her way home she couldn’t help but notice the strange stare she was receiving from everyone in the neighbourhood…it was the kind of stare you get when you’ve been tagged with something you are completely unaware of. People were muttering among themselves and giggling then she finally heard someone whispering; “that is the daughter of that witch who confessed today”. When she finally got home she met her mum’s younger sister, aunty Christy, who broke the news to her that her mum had been taken to Psychiatry Hospital.
As years rolled by, they had to leave their neighbourhood because it became increasingly difficult to bear the shame of being “affiliated to a witch”. For many years Seun and her siblings (who truly believed thier mum was a witch) never wanted to be associated with her and lost a lot of quality time they could have spent with her. Seun is about 25years old now, she is better informed about mental illnesses, and her mum who has since been on medication is now able to cope and effectively play her roles as wife, mother and grandmother. In retrospect she and her siblings now know that the accusations of their former neighbours against their mum were false. Clearly her mum was a victim of an old African belief fueled by ignorance…

“…why was this man born blind? Was it a result of his sins or those of his parents?”

This statement clearly portrays the general attitude towards those who are ill. People often look for “whom” or “what” to blame. A frequently asked question is “what is the cause of mental illness?” Many solely attribute it to a “spiritual attack” and our movies help promote this belief.
Mental illness is more common than most people realize but the general public know so little about it hence there is a wrong attitude toward those who are ill: some are accused of being evil or to have done evil subsequently bringing the illness upon themselves, others are locked in chains, treated cruelly and generally denied access to the community so they don’t bring shame to other members of the family. In this article I will attempt demystifying some of the myths about the cause of mental illness.
A lot has changed in the last 50years regarding treatment of the mentally ill with the advent of medications for treating mental illnesses. More than 65% of individuals with mental illness respond and improve with medications while only less than 35% of them remain permanently affected despite treatment. In these years a lot of research has been done in an attempt to pin point the cause of mental illness, some impressive discoveries have been faulted in the methods used in arriving at their results and so many of these experiments could not be replicated. No one reason has been found to fully explain the cause of mental illness. Psychiatrist and psychologist generally agree that mental illness results from an interaction of multiple factors including genetics, biochemical, social and psychological factors. A popular explanation is called the Stress-vulnerability model Hypothesis.
This model hypothesis simple states that ones vulnerability to developing mental illness meets with a form of stress and this interaction leads to the breakdown. Ones level of vulnerability or the nature of stress needed to trigger a mental illness can not be measured because it varies from one individual to another. It is suggested that someone with very high susceptibility will need a seemingly small measure of stress to break down while someone with a low susceptibility may need a higher measure of stress to break down.
One generally acceptable way of looking at the cause of mental illness is a chronological view which breaks it down to three aspects; predisposing, precipitating and perpetuating factors.

· Predisposing factors (WHAT MAKES ONE VULNERABLE); this refers to what makes an individual vulnerable to breaking down. This may arise from genetic make up, events in the womb and around delivery and other physical, psychological and social factors in infancy and early childhood. It is true that mental illness appear to “run in families”, for example, over 40% of people diagnosed with one form of mental illness called bipolar affective disorder have a family member (either past or present, nuclear or extended) with either the same illness or major depression. An individual’s personality also adds to the vulnerability factor for example someone who is prone to worry and anxiety would be more vulnerable to suffer from a major depression than someone who is not.

· Precipitating factors (WHAT COULD TRIGGER IT); this refers to events that are suspected to have triggered off the illness. They could be physical, social or psychological. For example a physical trigger factor may be fever, brain tumour, abuse of some street drugs, head injury etc. Psychological and social trigger could be positive like a promotion at work, birth of a baby or it could be negative like a bad relationship, death of a loved one etc. It is a proven fact that stressful life events triggers off mental illness. It could be a single event or a series of events which eventually lead to the psychological break down.

· Perpetuating factors (WHAT COULD MAKE IT PERSIST OR RE-OCCURE), these are issues that probably maintain the illness or bring about a reoccurrence of the illness. You may as well say these are factors that “feeds” or “fuels” the illness even when the predisposing and precipitating factors are no longer significant. For example certain attitudes like hostility, being emotionally over involved or sheer criticism, referred to as high expressed emotion, tend to increase chances of reoccurrence of a schizophrenic illness. Some situations could act as both a precipitating factor and a perpetuating factor for example a physical illness or a bad relationship so unless these are addressed the illness will continue despite treatment.

Though attempts to explain the cause of mental illness is controversial and complex topic because it doesn’t follow the regular cause and effect model of other physical illnesses, the stress-vulnerability model has been one of the best hypotheses (at least in my own opinion) put forward. It helps explain why two individual will go through similar experience and one will break down while the other wont. It also attempts to explain why some seem to do better while ill. My desire is to disabuse various minds of always looking for “who” or “what” to blame or solely attributing all mental illness to be a result of a spiritual attack.

Winning over story (formerly called when the clouds gather)

I first realized in my 400 level. It was pharmacology class and the lecturer had come in to teach on the topic antidepressants. He briefly listed symptoms of depression and looking at the board I was amazed because it appeared someone had told him about me: for about 2years I had seemingly lost my drive for competition and my grades were on the decline, I was often unhappy without any cause, I had distorted opinion about my colleagues I studied with, I had low self esteem and often thought of how the world would be without me?

I had grown up in a home environment where as far as I could remember I would see my parents fighting and as a little boy (less than 6years) I would coil up in a corner and cry. Then my parents separated when I was about 6years old. My dad had warned us to always run away from our mum whenever we saw her coming and we got seriously beaten whenever he found out we had talked with her. Leaving without a mother’s influence affected my personal hygiene since I wasn’t being properly supervised. I would go to school with dirty clothes primarily because I was too lazy to wash my clothes and I often forgot to brush my teeth, (which I almost overdo now, I guess I’m trying to make up for the past) apologies to those who I tortured with my bad breath back then.
Though my siblings were and still are wonderful and my dad did the best he could, I often silently prayed that one day someone would show up at the door and say “I’m your real father and I have come to take you home”. One particular day in my memory, my dad said to me;“ I have given you education, food, covering and clothes”…. And immediately, something in me quickly responded... “But something is missing” and, even though I was barely an adolescent, I knew within me he did not show me “love”.

My wife had prayed that she wanted someone who loved God and had been active serving Him but who wasn’t really happy so she could bring joy into that someone’s life because she knew she had so much love to give. After we got married she became disturbed and frustrated when I got depressed and start making remarks about her lack of love and submissiveness towards me. These were false accusations and largely arose from my distorted thinking. Whenever we had disagreements, I would sulk for hours and even think of ending my life… you will agree, that’s just being stupid. The best way I like to describe depression is that, it is like a dark “cloud” that comes over you and sort of envelopes you, weighing you down and compelling you to think pessimistically until it wears of f and this could take weeks to months. The feeling is uncomfortable and very distressing not just for the one who feels that way but also for others around him. At a point my wife wrote in a diary “I knew he was damaged but I never knew the level of the damage his early childhood experiences had on him”.

I received Jesus as my Lord and Saviour at an early age of about eleven so for me the church became my haven. Even though I didn’t start feeling depressed until I was about twenty-one, the words I heard in church and the scriptures I read in the Bible constantly kept me going. I later discovered when I started my specialty training in psychiatry that mild to moderate conditions of depression could be treated with cognitive behavioral therapy (CBT) with or without medications. CBT entails restructuring the mindset from the usual “automatic” negative thoughts that come with depression. I realized that all this while why I never broke down and had need to take medication was because I was receiving CBT via the WORD of GOD.

Even though I was saved I still struggled with depression and with my “new” knowledge of psychiatry from my medical training I sought for answers. My knowledge kept robbing me in, helping me with reasons to justify my actions. Then I realized that regardless of my background and my past experiences, the Bible says “…If any man is in Christ he is a new creation; old things have PASSED away; behold, all things have become new. Now all things are of GOD”…II cor. 5vs17&18. I stopped giving excuses for my actions; trying to explain the psychiatry theory and dimension to my struggles with these “automatic” negative thoughts rather I started confessing those words. Any time the cloud of depression came I would speak those words to myself. Rather than trying to understand myself and settling with knowing why I acted the way I did, I started seeing myself in the light that Jesus saw me as revealed in the WORD of GOD (the Bible). I received that picture into my heart and I now walk in it. The truth is, I can actually say, the Word of GOD did not only buffer me from the effect of depression, it actually made me free (cured me) from it. I believe He would do same for you or your loved ones who struggle with the “cloud”. God bless you.