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How Our Own Distorted Perceptions Afflict The Mentally Ill

17/12/2016 7:35 PM IST | Updated 21/12/2016 3:57 PM IST
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It reminds me of René Descartes, the renowned 17th century French philosopher, every time I come across a person with mental illness being greeted with the derision and loathing that is totally unmerited and unwarranted. Known for his famous statement, "I think, therefore I am", Descartes ventured to propose that brute animals are mere automata devoid of a "soul" that can think and reason. The premise, though later refuted by most philosophers, had far-reaching implications on the perception of (and thus the treatment imparted to) animals. Quite predictably, this concept also encroached upon the territory of mentally ill individuals. While I would like to believe that today, in the light of scientific reasoning, we have grown beyond this potentially disastrous premise for animals–the situation with the mentally ill is sadly little better.

The character of mental illnesses to affect the so-called "soul in the machine" enfeebles our perception of the patient... and elicits our repugnance rather than our compassion.

Such is the magnitude of the problem of human rights violations with the mentally ill that the World Health Organisation decided to declare it as a worldwide emergency. However, the plight of the mentally ill has always been a subject of social apathy, not just in India but in many parts of the world. Despite moving on from a predominantly custodial approach to institutional management of the mentally ill, and then making a leap into community-based care in recent times, we haven't fully succeeded in consolidating the idea that mental illnesses are just another category of afflictions. Like physical illnesses, they can show up anytime and in anyone; can be successfully managed with medical care, often up to complete resolution; and that many of such patients can be rehabilitated into a minimally dependant life. Mechanisms to protect the mentally ill and principles pertaining to insanity defence continue to be ill-defined and rather rudimentary in a number of nations, and the cudgels raised in their support soon lose their vigour and momentum. Such inertia towards mental illnesses, which more or less pervades society and transcends medical, political and legal spheres, suggests that there is something fundamentally wrong with how we perceive the mentally ill.

One of the features which set mental illnesses apart from their physical counterparts is that they affect a greater part of what constitutes an individual's "self", or their very status as a human being, than any physical illness possible. In simpler words, while physical ailments affect more of what "belongs to you", mental illnesses directly disfigure "who you are". Given this feature, a severe mental illness impeaches a person's very status as a rational being and has the potential to change our entire perception of them. This deformity of perception, therefore, obscures the helpless victim, the sufferer that lies inside a mentally ill individual. It also explains why many of us fail to sympathise with them and regard them with contempt and ridicule rather than the sympathy they rightly deserve. The character of mental illnesses to affect the so-called "soul in the machine" enfeebles our perception of the patient as a sufferer, degrades them to the status of brute-like automat, earns them the tag of a menace and elicits our repugnance rather than drawing out our compassion.

The inertia of societies translates to the inertia of governments and legislatures, thus rendering the mentally ill to be the most underrepresented sections of society.

A look into history would show how this deformity of perception has proven to be a constant nemesis of the mentally ill and their upliftment. Issues pertaining to the mentally ill and their plight have never caught on with societies to the degree that issues such as racism did. The inertia of societies translates to the inertia of governments and legislatures, thus rendering them to be the most disadvantaged and underrepresented sections of society. It would also be prudent here to mention that this deformity of perception is also responsible for a number of fallacies and myths which go with mental illnesses: from labelling them as "shameful" to the belief that the larger population is somehow insulated from them.

Now, let me bring you to the Indian scenario. With a dismal psychiatrist-population ratio and woefully inadequate institutional facilities, the greatest burden of the mentally ill falls upon the community. No surprise as to why India spearheaded the inclusion of mental health services with primary care and was among the first countries with a progressive and comprehensive mental health programme. Even today, as you try to understand the plight of the mentally ill, you realise that the biggest share of the blame lies with the discrimination and social isolation they are subjected to from the community. This shows how important community attitudes are, and with them being shaped and moulded by perceptions, the role of a robust mental health education becomes all the more important in the Indian setting.

As you try to understand the plight of the mentally ill, you realise that the biggest share of the blame lies with the discrimination and social isolation they are subjected to...

Health education is deemed as a tool with a wide coverage, given that it can generate a lot of impact with relatively less effort and expenditure. However, unless health education programmes are carried out with phenomenal diligence, they yield rather miserable results in terms of attitude conversion. It is well known that in the Indian scenario, health education programmes tend to be highly ambitious on paper but fail to deliver on the field. At times, the sheer slack in their implementation makes a mockery of their very purpose. In this setting, you can imagine how unpromising the picture looks with respect to mental health.

Mental health education needs to be revamped with a renewed sense of meaning if we wish to positively impact the plight of the mentally ill in India. The fact that a community-centred system such as ours takes the hardest hit from erroneous collective perceptions should confer health education primacy over other modes of intervention. A new paradigm of mental health education needs to be built if we want to bring about any significant improvement in the lives of our mentally ill, and the biggest challenge that lies ahead of us is the uphill and arduous task of recasting our deep-seated perceptions.

A spectator of human history would recount it to be the most ironic thing ever— that a society comprised of minds has always been so hung up on unsound bodies and so apathetic towards those unsound of mind. Our apathy towards the mentally ill has been a conspicuous blot on the list of our achievements as intellectual beings, and ushering into a new era of intellectual and philosophical superiority would be meaningless unless this is rectified.

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