Mental Health Crisis in India

More than 50 million people in India suffer from a mental illness.  In 2011, India recorded the highest rate of major depression in the world at 36 per cent.  According to doctors, roughly 10 per cent of India’s population suffers from depression – MGMH

 

Women with mental illness are treated as less than human.  They are dumped, abandoned and abused.  If there are any signs of mental illness, a woman is put in a mental hospital with no chance of getting out.  Men can go back home while women are there for life.  In the following video, we meet a woman whose husband had her institutionalized although she had no history of mental illness.  Here’s a story of a mentally ill woman whose husband built a case against her so that he could get custody of their children after divorcing her.

It is not surprising that women suffer from depression at higher rates than men.  They have to deal with gender inequality, violence, lack of paid employment, lack of education, excessive spousal alcohol use and poverty.  Mothers are blamed for the birth of a female child and many face pressure to have male children.  Women are diagnosed with schizophrenia later in life, oftentimes, following the birth of their children.  The children are often removed from the ill mother’s care and this results in further distress for her. Indian women have higher rates of suicide than women in most developed countries and a higher rate of suicide compared to men in India.  Depression is one of the most common reasons for suicide among Indian women.

Mental health in India carries with it a stigma, especially if the person suffering from mental illness is a woman.  According to MGMH (Movement for Global Mental Health), in rural India, it is common to see people taking their children to temples and faith-healers instead of hospitals and doctors, especially in cases of mental health.  Mental health was something that was talked about in hushed tones.  Thankfully, it is no longer being swept under the rug.  People are coming forward.  Deepika Padukone stunned her fans last year when she admitted that she suffered from anxiety and depression.

At the time the news broke, she was one of the most sought after actresses in Bollywood. It took tremendous courage for her to disclose her illness, especially since people diagnosed with mental illness face discrimination.  Deepika has since launched the Live Love Laugh Foundation to raise awareness about mental health issues and as a result many celebrities were inspired to come out in the open and address the need to talk about mental health.  Varun Dhawan admitted that he was depressed during the making of Badlapur and Honey Singh revealed that he has been undergoing therapy for bipolar disorder.

Sadly, those living with mental illness are victims of a cruel fate.  They are often locked away and stripped of their basic human rights in state-run institutions that are under-staffed. In an article, titled Mentally Ill Suffer a Horrible Fate in India posted on the site for Deutsche Welle (DW), most state run mental hospitals are in deplorable conditions. The National Human Rights Commission (NHRC) reported that out of the 43 government mental hospitals in India, less than half a dozen are in a “livable” condition”.

There are doctors in charge of these hospitals who have no business being there.  “These doctors don’t understand the intricacies of a psychiatric illnesses and the comprehensive care the patients require,” said a psychiatrist working in a state-run mental hospital in Uttar Pradesh.

And in the midst of the crisis of hospitals not providing the conditions and care the patients need, are quack healers who are profiting from this.  According to a study by Dr. Shiv Gautam, former superintendent of Jaipur Mental Hospital, 68 per cent of the mentally ill are taken to faith healers before a psychiatrist.  “The reason, besides superstition, is that most general medicine doctors fail to diagnose psychiatric illness,” Gautam said. “A mentally ill patient displays symptoms which superstitious people believe are paranormal,” he added. “Such patients are tortured, chained and used for extracting money from their families.”  Hema, who was suffering from Schizophrenia was believed to have an evil spirit.  Her family took her to Datar Sharif Dargah where she spent a year locked up.  It wasn’t until her condition deteriorated that she was brought to Dr. Gautam.  In 15 days, she began to improve and a month later she was normal.

In other cases, the mentally ill are subjected to one of these horrific ordeals:  whipping, caning, inhaling burnt chili smoke, having their eyes smeared with chili paste or having their eyes branded with red, hot coins.  There are laws banning this practice, however, many dargahs and temples keep the patients chained.  Some of them spend the rest of their lives like this.  In 2001, 26 patients perished in a fire at a dargah in a coastal village because they couldn’t escape the blaze since they were chained.  What a horrific and senseless tragedy.

Families of mentally ill people opt for dumping them.  This means that they are dumped into an asylum where the conditions are not fit for a human.  When an illegal asylum was raided, they found thirty-five men and six boys living in inhuman conditions.  The stench from their unwashed bodies and the excrement drove neighbors to alert the health department.  Naked and chained inmates were discovered, dumped there by their families after they paid the asylum owner.  Some of these poor souls were found crawling in their excrement, some even consuming it.  On their bodies were marks of torture.  Some had surgical scars on their backs, leading to allegations that the asylum had links to kidney theft.  78 patients had entered the asylum but only 41 were found during the raid.

Other patients are dumped in jungles or forests ranges.  Their families pay lorry drivers to drop them.  Women and children are among these victims and in some cases, the females are raped by the drivers before being dumped.  Social activist Murugan S. who has rescued countless mentally ill people from the streets, cautions us not to judge the families by calling them cruel.  Instead we are to examine what forced them to take such extreme measures.  He believes that system needs to change.

Part of the solution is raising awareness.  The suffering of the mentally ill has been brought to our attention. It is out in the open.  The next thing that needs to be done is to show the superstitious and fearful society that mental illness is nothing to run away from or to be ashamed of.  The person suffering from mental illness needs love, support and most importantly, proper care so that he or she can live a normal life.

The government needs to put something place to ensure that patients are placed in reputable, sanitary facilities that will provide the care that they need and to ban the operation of illegal asylums and the practice of dumping.  Quack healers should be banned from profiting from other people’s suffering.  Husbands should not be allowed to institutionalize their wives if there is no record that they have mental illness.

No one wants to be mentally ill but it is a reality for many people and what they need is to know that they have a platform where they can talk about what is happening with them. Here in Canada, we have Bell Let’s Talk, a wide-reaching, multi-year program designed to break the silence around mental illness and support mental health all across the country. It has done so much to fight the stigma of mental illness and encourage people to get involved in educating themselves and others.

It is my sincere hope and prayer that something will be put in place in India so that attitudes toward mental illness would change and those suffering from it will have a platform where they would not be judged, dumped, abandoned or discriminated but supported and be treated with dignity and open minds.  In the meantime, let’s keep talking and raising awareness.

Talking is the best way to start breaking down the barriers associated with mental illness – Bell, Let’s Talk

 

Sources:  Vice News; Movement of Global Mental Health; Wikipedia; Deutsche Welle

Women and Bipolar Disorder

The first time I was aware of bipolar disorder was years ago in New York.  It was there that I learned that my sister was manic depressive.  She had suffered from a nervous breakdown.  I never knew that she was manic depressive.   It was not evident to me.  She seemed fine to me.

While living in New York, she only had one episode where she had to stay in the hospital overnight but after that she was fine.  She had a good doctor who was diligent in her care.  I have other relatives who suffer from bipolar disorder.  And a co-worker of mine is no longer working because she had a relapse.  The last time I saw her I couldn’t believe it was the same person.  She called me on the phone and she was saying things that didn’t make sense and using language I never expected to hear coming out of her mouth.  I realize that when a person has bipolar disorder, he or she is different.  The illness changes the person.  Things from the past are dredged up, there are resentments and the belief that there is a conspiracy against him or her.

It’s hard to see someone you love suffering from a mental illness.  It’s harder when the person comes off of the medication and winds up back in hospital.  Each time he or she comes off the medication, it becomes harder to get back on track.  And the scary thing is they get into debt or in some cases trouble.  It’s hard for family members to know just how to cope, especially if during these episodes harsh and hurtful things are said.  It’s so disappointing when the person is doing well for a long time and then there is a relapse.  Each time he or she gets better, you are wary, wondering how long it would last.  Each time he or she promises not to come of the medication and vows to stay out of the hospital but something happens and there is an episode.

Even though I am aware of bipolar disorder, I still don’t know much about it.  I thought that I would search the web and gather all the information I could find just to get a better understanding of the illness.

What is Bipolar Disorder?
Bipolar disorder, formerly known as manic-depressive illness, is a brain and behavior disorder characterized by severe shifts in a person’s mood and energy, making it difficult for the person to function. More than 5.7 million American adults or 2.6 percent of the population age 18 or older in any given year have bipolar disorder. The condition typically starts in late adolescence or early adulthood, although it can show up in children and in older adults. People often live with the disorder without having it properly diagnosed and treated.

What are the symptoms of Bipolar Disorder?
Bipolar disorder causes repeated mood swings, or episodes, that can make someone feel very high (mania) or very low (depressive). The cyclic episodes are punctuated by normal moods.

Mania Episode Signs and Symptoms:

• Increased energy, activity, restlessness
• Euphoric mood
• Extreme irritability
• Poor concentration
• Racing thoughts, fast talking, jumping between ideas
• Sleeplessness
• Heightened sense of self-importance
• Spending sprees
• Increased sexual behavior
• Abuse of drugs, such as cocaine, alcohol and sleeping medications
• Provocative, intrusive or aggressive behavior
• Denial that anything is wrong

Depressive Episode Signs:

• Sad, anxious or empty-feeling mood
• Feelings of hopelessness and pessimism
• Feelings of guilt, worthlessness and helplessness
• Loss of interest or pleasure in activities once enjoyed, including sex
• Decreased energy, fatigue
• Difficulty concentrating, remembering or making decisions
• Restlessness and irritability
• Sleeplessness or sleeping too much
• Change in appetite, unintended weight loss or gain
• Bodily symptoms not caused by physical illness or injury
• Thoughts of death or suicide

Apparently there are several types of bipolar disorder but the two main ones are bipolar I and II.  Bipolar type I disorder is the “classic” form, and patients often experience at least one full or mixed episodes with major depressive episodes. Bipolar type II disorder is where patients have at least one milder form of mania and one major depressive episode.  However, they never get a full manic or mixed episode.  Bipolar II is harder to diagnose because some symptoms of hypomania may not be as apparent. Hypomania is described as a milder form of mania with less severe symptoms.  I believe that my sister displays more symptoms of mania.

All the people I know who have bipolar disorder are women.  Although it is prevalent among men as well, it seems that it is approximately three times more common in women than in men.  For women it is rapid cycling.  Rapid cycling describes incidences where a bipolar patient experiences four or more episodes of mania, hypomania, or depression within a time period of a year (Leibenluft, 1997).

The article explains why rapid cycling bipolar disorder more common in women than in men. Three potential hypotheses to explain the higher prevalence of rapid cycling in women are hypothyroidism incidence, specific gonadal steroid effects, and the use of anti-depressant medications. First, more women encounter hypothyroidism than men do; however, there is not a general consensus on it being a primary cause of increased rapid cycling. Second, gonadal steroids, such as estrogen and progesterone, fluctuate throughout the menstrual cycle. Sixty-six percent of bipolar type I women had regular mood changes during either their menstrual or premenstrual phase of their cycle. They were more irritable and had increased anger outbursts (Blehar et al., 1998). These may set up women to frequent mood changes (especially prior to the menstrual cycle, as noted in the term “premenstrual syndrome”). Increased estrogen may cause women to develop hypercortisolism, which may increase the risk of depression. Stress levels are associated with cortisol level, so this may possibly be the reason for increased risk for depression.

There are risks involved in pregnant women who suffer from bipolar disorder.  Manic episodes and cycling seemed to occur exclusively during pregnancy.  For reasons still unclear, apparent pregnancy poses a question of relapse, which has an important effect on women and the fetus that they are carrying. The fetus can be at risk due to lack of attention to prenatal care, if the woman is not treated for the psychiatric illness. Precipitated episodes in the absence of treatment may be very detrimental to both parties involved. Secondly, the woman would be at risk because with each successive episode, the length of time to following episodes gets smaller. That is, the woman could have manic and depressive episodes more often. This would neither be beneficial to the woman or her child. The effect on the fetus due to many mood episodes is unclear (Viguera et al., 1998). “During pregnancy, a woman’s glomerular filtration rate increases” (Llewellyn et al., 1998). This means that any medication that she takes, such as lithium (discussed below), will be excreted more rapidly. This is very dangerous because if she does not have enough medication in her system, she can fall into relapse.

A dilemma arises in that if she increases her medication amount, she may be exposing her fetus to grave side effects and even danger (discussed below). Moreover, during labor, it is important that women remain fully hydrated. Since the period of time for delivery varies with each individual, a pregnant woman can become very dehydrated. When a woman gets dehydrated, the serum medication concentrations will increase (Llewellyn et al., 1998). This is the opposite effect of the increase in glomerulus filtration. Nonetheless, both situations are dangerous and can be very toxic to the woman and indirectly to the fetus.  As varying as the symptoms of bipolar disorder, per individual, so are the treatments. It is very important that bipolar pregnant women get the appropriate care and treatment that they need, in order to properly care for themselves as well as for the child that they are carrying.

It is disturbing to know that women with bipolar disorder are more susceptible to misdiagnosis.   recent study estimated that the odds that a woman with bipolar disorder will fail to be correctly diagnosed are roughly three times the odds for a man. This disparity may be explained in part by the fact that bipolar disorder tends to look different in women than it does in men—in the same way that physicians sometimes fail to catch heart disease in women because they are effectively looking for the male version of the disease, mental health professionals may not always be aware of the distinctive signs of bipolar disorder in women.  According to Vivien Burt, MD, PhD, director of the Women’s Life Center at UCLA’s Resnick Neuropsychiatric Hospital, “Women are more demonstrative—they have more of what’s known as ‘affective loading’—so it’s not surprising that bipolar disorder might be underdiagnosed in women compared to men.”

Another article stated that a woman is likely to have more symptoms of depression than mania.  And female hormones and reproductive factors may influence the condition and its treatment.  Research suggests that in women, hormones may play a role in the development and severity of bipolar disorder. One study suggests that late-onset bipolar disorder may be associated with menopause. Among women who have the disorder, almost one in five reported severe emotional disturbances during the transition into menopause.  Studies have looked at the association between bipolar disorder and premenstrual symptoms. These studies suggest that women with mood disorders, including bipolar disorder, experience more severe symptoms of premenstrual syndrome (PMS).

My sister had the disorder since she was in her thirties.  She is unmarried and doesn’t have any children.  If she had children would they be at risk?  Bipolar disorder is more likely to affect the children of parents who have the disorder. When one parent has bipolar disorder, the risk to each child is estimated to be 15-30%.  Bipolar symptoms may appear in a variety of behaviors. According to the American Academy of Child and Adolescent Psychiatry, up to one-third of the 3.4 million children with depression in the United States may actually be experiencing the early onset of bipolar disorder.

If you notice mood swings in yourself or someone else, don’t write them off as hormonal changes.  Seek medical help.  And if you are diagnosed with bipolar disorder, consult a psychiatrist or a general practitioner with experience in treating this illness.

My sister is currently on disability.  A bipolar diagnosis can have a great effect on your job and career.  In a survey of people with depression and bipolar disorder conducted by the Depression and Bipolar Support Alliance, 88% said their condition affected their ability to work.  Don’t be discouraged, though.  Being diagnosed with bipolar disorder doesn’t necessarily mean that you can’t keep your job. Plenty of people with bipolar disorder work and live normal lives.  If you are currently unemployed and are seeking employment, find a job that is a good fit for you–one that is not stressful and has a flexible schedule.  If you are currently in a job that is not working for you–is affecting your health, not letting you get enough sleep, maybe it’s time to make some changes.  Here are some things you should consider:

• Decide what you really need from your job. Do you need to reduce your responsibilities? Do you need extra breaks during the day to reduce stress? Would you rather work independently or in a group? Do you need to work shorter hours or take time off? Or do you need a different job altogether?
• Make decisions carefully. People with bipolar disorder are prone to acting impulsively. Think through the effects of quitting your job — both for yourself and possibly for your family. Talk over your feelings with your family, therapist, or health care provider.
• Look into financial assistance. If you do need to take time off because of your bipolar disorder, see if your employer has disability insurance, or look into Social Security Disability Insurance, which will provide some income while you recover. You can also look into the Family and Medical Leave Act. Ask your doctor or therapist for advice.
• Go slowly. Returning to work after you’ve taken time off can be stressful. Think about starting in a part-time position, at least until you’re confident that your bipolar disorder has stabilized. Some people find that volunteer work is a good way to get back into the swing of things.

Unfortunately you may encounter stigma at work.  Some people might treat you unfairly because of your disorder.  If you feel that you are being passed over for promotion or are being treated unfairly, there are things you can do.  Find out what policies are in place at your company that will protect you from this kind of discrimination which is illegal.    The Americans with Disabilities Act can protect some people who are discriminated against because of a health condition.  Before you do anything, research the law and talk things over with family, friends and therapist.  Mitzi Waltz, author of “Adult Bipolar Disorders,” advises bipolar employees to call a counselor or local support group to help them with workplace problems.

Bipolar disorder is tough on families and spouses.  They have to cope with behavioral problems.  Family members often experience feelings of extreme guilt after the individual is diagnosed. They are concerned about having had angry or hateful thoughts, and many wonder whether they somehow caused the illness by being un-supportive or short-tempered, although this is not the case.  There are times when I feel guilty because I didn’t touch base with my sister as often as I should have.  There are times when I am frustrated with her for coming off her medication because she is aware of what happens when she does.  I feel that she should take more responsibility for keeping the disease under control by taking her medication.  I see how her relapses affect my mother who has Parkinson’s.

I realize that although it is difficult to cope, families of patients with bipolar disorder need to be more supportive.  It is in the best interest of the person to be hospitalized for his or her own protection and for much needed treatment if he or she is in the middle of a severe episode.  And it is important for the patient to  to understand that bipolar disorder will not go away, and that continued treatment is needed to keep the disease under control. It is important that they understand that proper therapy will enable them to have a good quality of life and enable them to have a productive life.

The following tips are for families who want to help their loved ones to cope with the illness:

1. Educate Yourself
2. Learn How–and When–to Talk
3. Make Some Rules
4. Plan Even More
5. Listen
6. Go Gentle
7. Laugh Together
8. Support Yourself

I encourage families of people with bipolar disorder to educate themselves and then see how they can help their loved ones to cope.

Sources:  http://bbrfoundation.org/frequently-asked-questions-about-bipolar-disorder; http://psychcentral.com/lib/2007/women-and-bipolar-disorder/all/1/; http://www.health.com/health/condition-article/0,,20274376,00.html; http://www.webmd.com/bipolar-disorder/guide/bipolar-disorder-women; http://www.bphope.com/BipolarIndepth.aspx; http://www.ehow.com/about_5032842_signs-bipolar-disorder-women.html; http://www.webmd.com/bipolar-disorder/going-to-work-bipolar; http://www.livestrong.com/article/23014-good-career-those-bipolar-disorder/; http://www.psychiatry24x7.com/bgdisplay.jhtml?itemname=bipolar_family; http://www.beliefnet.com/Health/Emotional-Health/Bipolar/8-Ways-to-Help-Your-Bipolar-Loved-One-Cope.aspx