Mental Illness

Health is defined as a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. A sound mind in a sound body has been recognized as a social ideal for many centuries. The Indian sages and seers had paid particular attention to the unconscious; wherein lay the suppressed unfulfilled desires and compulsions of several kinds which led the individual astray; by mastering their minds, they attained the highest levels of emotional equilibrium. Mental health is thus the balanced development of individual’s personality and emotional attitudes, which enable him to live harmoniously with his fellow men.
Characteristics of a mentally healthy person
A mentally healthy person has three main characteristics:
1. He feels comfortable about himself that he feels reasonably secure and adequate. He neither underestimates nor overestimates his own ability. He accepts his shortcomings. He has self-respect.
2. The mentally healthy person feels right toward others. This means that he is able to take interested in others and to love them. He has friendships that are satisfying and lasting. He is able to feel a part of group without being submerged by it. He is able to like and trust others. He takes responsibilities for his neighbors and his fellow men.
3. The mentally healthy person is able to meet the demands of life. He does something about the problems as they arise. He is able to think for himself and to take his own decisions. He sets reasonable goals for himself. He shoulders his daily responsibilities. He is not bowled over by his own emotions of fear, anger, love or guilt.
Warning signal of poor mental health
1. Are you always worrying?
2. Are you unable to concentrate because of unrecognized reasons?
3. Are you continually unhappy without justified cause?
4. Do you lose your temper easily and often?
5. Are you troubled by regular insomnia?
6. Do you have wide fluctuations in your moods from depression to elation, back to depression, which incapacitate you?
7. Do you continually dislike being with people?
8. Are you upset if the routine of your life is disturbed?
9. Do your children consistently get on your nerves?
10. Are you “browned off” and constantly bitter?
11. Are you afraid without real cause?
12. Are you always right and the other person always wrong?
13. Do you have numerous aches and pains for which no doctor can find a physical cause?
Cause of mental health
Mental illness like physical illness is due to multiple causes. There are many known factors of agent, host environment in the natural histories of mental disorders. Among the known factors are the following:
1. ORGANIC CONDITIONS: Mental illness may have their origin in organic conditions such as cerebral arteriosclerosis, neoplasm, metabolic diseases, neurological diseases, endocrine diseases and chronic diseases such as tuberculosis, leprosy, epilepsy, etc.
2. HEREDITY: Heredity may be an important factor in some cases. For example the child of two schizophrenic parents is 40 times more likely to develop schizophrenia than is child of healthy parents.
3. SOCIAL PATHOLOGICAL CAUSES: To produce any disease there must be a combination of genetic and environmental factors. The social and environmental factors associated with mental ill health comprise: worries, anxieties, emotional stress, tension, frustration, unhappy marriage, broken home, poverty, industrialization, urbanization, changing family structure, population mobility, economic insecurity, cruelty, rejection, neglect and the like.
Environmental factors other than psychological ones capable of producing
Behavior is:
1. Toxic substances: carbon disulfide, mercury, manganese, tin, lead, compounds etc.
2. Psychotropic drugs: barbiturates, alcohol, griseofulvin.
3. Nutritional factors: deficiency of thiamine, pyridoxine.
4. Minerals: deficiency of iodine.
5. Infective agents: infectious diseases (e.g. measles, rubella) during the prenatal, perinatal and post-natal period of life may have adverse effects on the brain’s development and the integration of mental functions.
6. Traumatic factors: road and occupational accidents.
7. Radiation: nervous system is most sensitive to radiation during the period of neural development.
Crucial Points in the Life Cycle of Human Beings
There are certain key points in the development of human being which are important for mental health. These are:
1. Prenatal Period – Pregnancy is stressful period for some women. They need help not only for their physical but also emotional needs.
2. First 5 years of life – The roots of mental health are in early childhood. The infant and young child should experience a warm, intimate and continuous relationship with his mother and father. It is in this relationship where underlies the development of mental health. It follow that broken homes are likely to produce behavior disorder in children.
3. School Child – Every thing that happen in school affects the mental health of a child. The programmes and practices of school may satisfy or frustrate the emotional needs of the child. Children who have emotional problems may need child guidance or psychiatric services.
4. Adolescence – The transition from adolescence to manhood is often a stormy one and fraught with dangers to mental health, manifested in the form of mental ill health among the young and juvenile delinquents.
5. Old Age – The mental health of the aged have received considerable attention. The causes of mental illness in the age are organic conditions of brain, economic insecurity, lack of home, poor status and insecurity.
Preventive Aspects
The three levels of preventions are
1. Primary – Primary prevention operate on a community basis. This consists of “improving the social environment” and promotion of the social, emotional, and physical well-being of all people.
2. Secondary – This consists of early diagnosis of mental illness and of social and emotional disturbances through screening programmes in schools, universities, industry, recreation center etc. and provision of treatment facilities and effective communicative resources. In this regard family based services have much role to play.
3. Tertiary – Tertiary prevention seeks to reduce the duration of mental illness and thus reduce the stresses they create for family and community.

For example a girl plunged in grief by the death of her companion, if taken to see a family where the poor, half naked children have just lost their father, their sole support, does not become more sorrowful from witnessing the troubling scene, but is thereby consoled for her own smaller misfortune; she is cured of her grief for her friend, because for the unity of her mind can not be affected by two Similar but stronger passion takes possession of her mind and acts as remedy in extinguishing the first.
Two thousand five hundred years ago a women came to Gautama Buddha with her dead baby whom she carried with her. She asked Buddha if he would resurrect her child. The Buddha said yes, less than one condition. Find a house (family) where no one has died and I will restore your child. She went house to house and soon the realized the universal nature of suffering and impermanence and gained insight. She returned to the Buddha to offer thanks, and then allowed the baby received its funeral rights and found peace.
Through the power of sympathy for grief and suffering of other one’s own healing process begins. This power behind this is compassion. The old psychologist notes that the suppression of grief by heterogeneous influences likes anger or strictness only caused more distress as doe’s palliative method like trying to make someone artificially happy.
There seems little doubt that “an extraordinary understanding for the nervous and mental activities of his patients and considered psychotherapy in certain cases to be more important, more applicable than the use of medicines”. He also seems to have been “far in advance of his time in this province”. Everyone seems to be agreed that he exhibited a “fine understanding for the unfortunate victims of mental derangement” and he acquired a reputation for same, attracting many patients with mental problems

The various types of mental diseases that he mentioned are:
Ө Type 1: - Where a mental and emotional disease begins as corporeal disease. From the symptomatology of the disease, in due course of time bodily symptoms disappear and mental symptoms dominate. This occurs to such a degree that it seems that the physical symptoms never existed. This class of illness may be called the true one-sided illness. The Major Depressive Disorder, Single Episode or any form of depression occurring for the first time without any apparent previous history may fit into this category. Cases where a life threatening illness suddenly transforms, by a rapid increase of psychical symptoms that were previously present, whereupon the corporeal symptoms loose all their danger; these later improve to perfect health, or rather they decrease to such a degree that their obscured presence can only be detected by observation of a physician gifted with perseverance and penetration. In this manner they get transformed into one-sided illness and as it were a local malady. This class may contain the cases of depression that occur after serious acute medical diseases have settled or after a complicated pregnancy e.g. Postpartum Depression, Depression due to a general medical condition, Depression due to organic brain disorder (Frontal Lobe disorder have marked effect on affect, could be depressive as well as manic).
Criteria for Type I:
(a) Origin: In the body (any bodily illness).
(b) Onset and Progress: Gradual, progressive.
(c) Cause: Mental illness (depression) due to physical ailments.
Type II: “Insanity or mania (caused by fright, vexation, etc.) has suddenly broken out as an acute disease in the patient’s ordinary calm state, like a flame bursting forth from it” Mainly the hysterical and acute psychotic illness fall under this category. As far as acute depressive episodes are concerned the Grief reaction, Depression following substance abused falls under this category. Case of brief depressive disorders that are intense enough but do not last for the time period that is specified and are caused due to loss of love one or a sudden business loss will be included under this type as the cause is sudden and the onset is sudden.
Criteria for Type II:-
(a) Origin: Mind.
(b) Onset and Progress: Acute sudden onset may be short / Progressive.
(c) Cause: Sudden mental stress; strong emotions, fear, fright, grief.
Ө Type III – Encompasses the mental diseases that are not quite developed, but result from faults of education, bad practices, corrupt morals and neglect of the mind, superstition or ignorance. These are generally people with an affective temperament that are easily prone to swaying moods in either direction. They are easily affected by trivial matters that will not have much impact on most people or some time shows a tendency to be affected without any apparent cause more than the normal population. They also show tendency to get disorganized by substance abuse, mostly alcohol. The previously understood Endogenous Depression (Major Depression) and Dysthymia fall under this type as the main reason is individual’s dispositional qualities that make him fall prey to depression. Absolutely no cause or a trivial cause may participate in an episode of depression or this may continue a seemingly endless course as dysthymic disorder.
Criteria for Type III –
(a) Origin – Chronic.
(b) Onset and Progress – Gradual onset and Progressive.
(c) Cause – Temperament (disposition), tendencies and life style leading to mental disturbances.
Type IV
They are maintained by psychical factors viz. continued anxiety, worry, vexation, wrong and frequent occurrences of great fear and fright. These illnesses are in their early stages i.e. when they have not affected body to a great extent, are amiable to any kind of friendly advice or changes in diet and regimen. These illnesses are a part of widely accepted class of Psychosomatic Diseases. The presentations are generally somatic in the form of some or the other diseases like Migraine Headaches, Acid Peptic Disease, Inflammatory Bowel Disease, and Bronchial Asthma etc. A large section of modern medicine researchers are now focusing on this theory of disease, which Hahnemann had coined centuries ago.
Criteria for Type IV –
(a) Origin – Mind
(b) Onset and Progress – Chronic, Long standing and Progressive
(c) Cause – Mainly emotional precipitating and maintaining causes mental stress, anxiety, worry, vexation etc. somatized leading to bodily ailments.
Plan of Management of Mental Illness

General Concepts –
This state that in cases of mental illness sometimes when the patient appears to be uncooperative for taking medicine then he can be deceived and given the medicines dissolved in water or any other drink that patient consumes as a small doses of appropriate medicine never offend a taste and may consequently be given to the patient without his knowledge in his drink, so that all the compulsion is unnecessary.


Specific Management –
Ө Type I - In these mental diseases we must be careful to make ourselves acquainted with whole of the phenomena, both those belonging to the corporeal symptoms, and also and indeed particularly, those appertaining to the accurate apprehension of the precise character of chief symptom of the peculiar and always predominating state of mind and disposition, in order to discover, for the purpose of extinguishing the entire disease, among the remedies whose pure effects are known, a medicinal pathogenetic force that is to say, a remedy which in its list of symptoms displays, with the greatest possible similarity, not only the corporeal morbid symptoms present in the case of disease before us, but also especially this mental and emotional states.
He describe the importance of physical symptoms that existed before the illness became one sided. The people around would be in a better position to recollect these as the patient, over a period of time, must have forgotten or may not be in good mood to describe them, as we all know the communication difficulty of individual with depression. The symptoms that come up during lucid interval are the expression of deranged susceptibility and are an extremely important part of the totality. After the phase has subsided by deep acting constitutional, remedies are required to complete the cure. This has to be conjoined with carefully regulated mode of life, an appropriate psychical behavior towards the patient on part of those about him and of the physician must be scrupulously observed, by way of an auxiliary mental regimen.
Ө Type II – For the treatment of acute mental diseases warrants against the treatment with remedies immediately but with a phase remedies covering the current mental state and causes the derangement. These may develop themselves completely, and pass into either a periodic or continued mental derangement, which is then more difficult to be cured by medicines.
Ө Type III –It is really one arising from physical affection, or did not rather result from faults of education, bad practices, corrupt morals, neglect of the mind, superstition or ignorance; the mode of deciding this point will be, that if it proceed from one or other of the latter causes it will diminish and be improved by sensible friendly exhortations, consolatory arguments, serious representations and sensible advice; where as a real moral or mental malady, depending on bodily diseases, would be speedily aggravated by such a course, the melancholic would become still more dejected, querulous, inconsolable and reserved, the spiteful manic would thereby become still more exasperated and the chattering fool would become manifestly more foolish.
Therapeutic Problem Definition and therapeutic Problem Resolution
A Synthesis
We have seen the advantages and limitation of the Modern Classification of Depressions, Anxiety and Somatoform Disorders in formulating the treatment. This system gives the TIME and SYMPTOM CLUSTER as also an idea of prognosis.
It is clear that the course of the Depressive and Anxiety disorders are chronic in nature. The management has to focus with this course of the disease in mind. The rate of relapses demand a therapeutic plan that will look into current state, the precipitating factors, the maintaining factors, the personality (disposition) of the patient with Family History acting as the predisposition.
A tabulation of these causative factors will help the treating physician to understand the forces he needs to deal with while affecting a cure in the sick individual. A table depicting the relative intensities of these various forces acting in a particular individual will help in evolving the plan of management for the individual case. The predominating force acting in an individual will demand a corresponding action in term of remedial or non-remedial forces in the treatment. For example if there is a significant precipitating cause resulting in depression (humiliation, disappointment in love etc.) then it will become one the most important symptom of the case. The disposition it self may go on creating difficulties for individual and will need a change in behavior or thinking pattern (behavioral or cognitive therapy) to minimize the complexities that get created knowingly or unknowingly.
The above considerations are evolved from a joint consideration of the classification of mental illness through both the systems.

The table can be thus formed:
Case
no

DSM
Axis
I and
III
Evolution
Mind
↨
Body
Causation
Classification


Predisposition Disposition Precipitating Maintaining




The therapeutic plan has to be formed on the assessment of all the disease modifying factors; the causative, aggravating and ameliorating factors, intensity of current state and the availability of symptomatology. The main aspects in symptomatology will be the characteristics mental and physical symptoms that are and were present in the history of the evolution of disease. This will also be dependent on the desired outcome of the case, and need at that particular moment of time.

NO PROBLEM DEFINITION RESOLUTION

PROCESS End-POINT
Methods and
techniques PRECAUTIONS AND
DANGERS






This table helps the treating physician to make a plan at the start of treatment by allowing him to pen down the symptoms and mental state that he wishes to treat in the order that he thinks is appropriate and according to the principles laid down those that have been evolved by modern system. The plan can be updated as per the progress of the patient under treatment and can be assessed to be according to the plan that was mentioned in the END POINT column.
Critical to the concept outlined above is that of susceptibility which enables the disease to take various forms and evolve over time. Susceptibility has defined as the capacity of the system to react to stimuli. We should be able to grasp the presentation of mental disorders on the correct appreciation of the various dimensions of susceptibility and be able to incorporate this understanding in to the therapeutic plan to formulate the posology required in every single case.
This will help in integrating the two systems of classification and also help to evolve therapeutic strategy that make the treatment of the most common illness – Depression, Anxiety and Somatoform Disorders.