05 August 2009

Destigmatising mental illness - a work in progress

While progress has been made in reducing the stigma associated with mental illness, there is still much work to be done and many myths that need to be dispelled.

While progress has been made in reducing the stigma associated with mental illness, there is still much work to be done and many myths that need to be dispelled. Dr Eugene Allers, a psychiatrist in private practice and one of the driving forces behind a campaign to destigmatise mental illness launched in the early 2000s, feels that education is essential to this process as ultimately prejudice is fuelled by ignorance. “A couple of centuries ago, people with epilepsy, for example, were burned at the stake. Because mental illness is invisible and mysterious, relative to something like a broken leg which is visible and easily explained, much religious significance was attached to it. It has therefore taken us a long time to reduce the stigma and we still have a long way to go before we eradicate it entirely.” Even today, people suffering from a condition like depression are often told, "pull yourself together" or "get over it". “Many people fail to acknowledge that the brain is an organ like any other. It too is made of flesh and blood, and its functioning involves a complex interplay of hormones, electrolytes, electrical impulses and oxygen, among others.

And as with other organs, things can go wrong. If your pancreas isn’t working and you develop diabetes, nobody is going to tell you to 'get over it'. Instead you’ll be advised to take your insulin," says Dr Allers. "Because their brains are malfunctioning, patients with a mental illness cannot simply pull themselves together.”

However, perceptions among the lay public continue to lag behind scientific reality. "For many, the brain remains something that should be left alone, even though the people who think this may be perfectly comfortable with taking an antibiotic or having an inoculation," continues Dr Allers.

'Going against God'
"Interfering with the brain is often perceived as going against God, but while religion gives a value system which is important, it isn’t a substitute for science, which over the past century, has explained so much of how the brain works. Neuroscience is the fastest-growing field of medicine today. We’ve made great strides from Freud’s theories in the early 20th century, through electroconvulsive therapy in the 1930s, to the advent of the first antidepressant, chlorpromazine, in the 1950s, the tricyclic antidepressants in the 1960s, to the modern drugs and advanced imaging technologies of today.”

He feels that this disconnect between science and religion where the brain is concerned is the root of the problem and that a paradigm shift is required. "As much as religion needs to acknowledge the validity of science, science needs the value system religion can provide. They need to work together."

Another myth is that mental illness is a sign of weakness. In fact, anyone can potentially develop a mental illness. "I often compare us to 1-ton bakkies. Put a 2-ton load in one, and you’ll bend the axle. But there’s nothing wrong with the bakkie. It just wasn’t built to cope with that weight. Similarly, human beings are only built to cope with a certain amount of emotional weight. The brain, like muscle and bone, has finite coping abilities."

Not a life sentence
It’s also a myth that a psychiatric condition is a life sentence. “We as doctors may be partly responsible for this impression," Dr Allers acknowledges. "This is because we have a tendency to use the term 'remission' rather than 'cure'. However, modern psychiatry can cure 80% of patients absolutely. In those cases where the condition is chronic, it can usually be extremely well-controlled. Today virtually no mental disease is untreatable and it’s very rare nowadays for patients to be restrained or locked away, as was once the case. And yet the view of psychiatric facilities as 'loony bins' is yet another misperception that refuses to go away."

Acknowledging all of this, he nonetheless feels that much progress has been made in recent years. He cites the following key example. "As recent as the 1990s, medical schemes classified suicidal behaviour as a wilful act – 'self mutilation due to a deliberate decision'. That’s akin to saying that you have a choice in whether or not to cough when you have pneumonia. Today, however, we have moved away from this completely and the Medical Schemes Act has mandated treatment for suicidality. It’s also encouraging that the law recognises the rights of mental patients when it comes to stigmatisation. Anyone who feels discriminated against should use these laws."

The next frontier will be really getting to grips with the causes of brain dysfunction. "We’re still largely treating symptoms/syndromes and much of the underlying causes and mechanisms are still shrouded. But more and more we’re starting to see that mental disease is not unlike other disease processes and that a number of different factors are involved. As science continues to clarify these, we should see further progress in destigmatisation," he concludes.

- Magna Carta, August 2009


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