Mental illness a health issue Replacing stigma with compassion

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By 2017-10-15

By Priyangwada Perera
Ceylon Today Features

Dressed in a clean fashionable t-shirt, he even wears a wrist watch. Though not physically fragile, he has a distant look in his eyes. Yes, even when he speaks to you. He is reported to have been found wandering around temples in Jaffna, Anuradhapura and Galle. Ceylon Today met him at the National Institute of Mental Health (NIMH) in Angoda.

He was brought to the NIMH through the Courts. When he first arrived at the NIMH he did not know how to eat his food and he used to collect his excreta on to the plate and apply it on the walls. It is after much personal care, drugs and Elector Convulsive Therapy (ETC) that he was brought to his present condition. "He said his name was Herath Banda but it was not his name. He also said that he was from Kandy. He seemed to know Gampola very well. From whatever facts we could gather about him, we called a Grama Niladhari from Kandy and got the assistance to locate his whereabouts," the nurse told Ceylon Today. Having lived with his mother and sister, once the mother passed away he is discarded. His sister refused to keep him at home. He wanders out. In spite of being cured, now, there is nobody willing to accept him back. He used to get angry and become aggressive. But not anymore."

"Angoda", that tell-tale name of the city itself can expect only one response. Even as the team got ready to go to the NIMH, it created much amusement. If going to Angoda sounds funny, how about meeting those who are receiving treatment at the NIMH? Going by societal norms, labelled and tagged as 'crazy', they are at the pinnacle of shame and humiliation. Their stories are sad. But the suffering is worse. Herath Banda is only one bead in a long chain of pain. How does one lose one's mind? Not out of carelessness, like losing a pencil.

Speaking to the Senior Registrar in Psychiatry, Dr.Thusitha Athurugiriya at NIMH, Ceylon Today queried about these patients "Do people come here when they reach a severe mental imbalance? Do we, as a society have a responsibility? Have we driven the person 'mad' to ask in lay terms? " Dr Athurugiriya responded, " To put it simply, we cannot say anybody is responsible for anything. Not the person or the family can be held responsible of his illness. But there are responsibilities. Patient has a responsibility to himself to take the medication and improve his quality of life. The same responsibility is there for the family to support, provide necessary care, help. Society has a social responsibility-particularly not to harm them and also not to neglect or discriminate them. Most are completely curable."

The biggest issue in Sri Lanka is that they are significantly discriminated. According to Dr. Athurugiriya, in developed countries there are legitimate actions to support such people. Government officials are assigned to look after these people and there are ways the employers can employ these people.

Mental health literacy
Dr. Athurugiriya continued, "Biggest problem is our mental health illiteracy. In other countries, there are enough reading material on mental health and they are included in the curriculum. In Sri Lanka it is considered taboo. Talking of it is not nice or acceptable. It is a reason to be ashamed of. It is a big disadvantage in our efforts to treat them. Because of this mental health illiteracy people try to go for alternatives. Culturally acceptable methods, but not so accurate in curing, like Devil dancing or Thovil. Our experience is that in going for these things they spend a lot of money. The same money can be well utilized to get the best treatment and use it on a future investment for the persons. Sometimes, these patients are hurt and traumatized by these traditional practitioners and customs. They take time and by the time the patient decides to get medical help, things have gone from bad to worse." Yet, Dr. Athurugiriya said we are comparatively better than say 20 years back. People now seek medical help in the early stages.

Ceylon Today also met *Nihal who could explain his situation. He went on to talk about his alcohol addiction. He had had a peaceful life at home but he got addicted to alcohol and that was the start of his downfall and explained how everyone at the hospital had helped in his recovery. Dr. Athurugiriya referred to this as an instance of a simple anxiety disorder, due to his dependency on alcohol. Dr. Athurugiriya brought up the case of a young Tamil girl who suffered from "delusional love". In her own beautiful world, she was desperately in love with a TV presenter. The situation got intense when she lands at the television station, declaring her love. Court decides she needs medical help and she is now at the NIMH.

Outside the NIMH, many of us would relate to that girl. Screaming fans going delirious is only a common scene. On media they create news, make exclusive photographs on magazine covers. Yet, a fraction above one invisible line of sanction, another young girl is diagnosed with a disease. The great Indian writer Saadat Hasan Manto wrote extensively on the metaphor of madness. How a set of 'mad' majority gets to judge someone else as 'crazy' because theirs is different to the majority. Dr. Athurugiriya spoke of the people abandoned in the town, who are finally brought to NIMH. They are easily the most cruelly judged and therefore heartlessly rejected by society. The nurse speaking to Ceylon Today said in spite of some of them being very aggressive and uncontrollable at the start, how a little improvement brings out the sheer vulnerability of these very people. "They call us 'My Miss'" and consider us their own. One nurse has one person that they specifically take care of. Each one has to be handled differently." Making them clean up, coaxing them to take their medicine regularly and even feeding some of them, for the kind nurses it is like raising a child. These 'rejects' of society are treated with unimaginable patience and gentle sternness. The nurse also spoke of how these patients are cured and once sent back home due to lack of supervision and help, some fall back to depression. "It is essential to continue medication throughout their lives. Unless there is a follow up, their situation might deteriorate. Because they have 'returned from Angoda' they become the laughing stock. Family, village and society rejects these people." All of us have our moments of insanity and get away with it. We still manage to stay within the so called limits decided by society. Rohinton Mistry, in his novel A Fine Balance writes, "Flirting with madness was one thing, when madness started flirting back, it was time to call the whole thing off." Calling it off cannot be done alone. What they need is our support and understanding.

(*name changed for privacy)

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