Monday, March 2, 2009

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.

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