PSYCHIATRY at the INDIAN Grassroots
Dr. Usha Nandini M,
Consultant Psychiatrist, Thanjavur, Tamilnadu
India is the 5th largest Economy in the world with a literacy rate of 76.32 %. Even though India is not so illiterate, it is still the world’s suicide capital with over 2.6 lakh suicide cases every year. Around 60-70 million people suffer from some sort of mental illness, of which 70-80% do not even seek any care in this regard. Why is the stigma still there?
Every day I come across patients who have decided to seek Psychiatric help after so much deliberation that their illness has become serious enough to cause significant morbidity. The sad part is not that, even with so many symptoms they expect the psychiatrists to talk the symptoms away. The psychiatrist in me is in a very sensitive position where I want to make sure that the patient receives the adequate care even if it is very late and also convince the caretakers that medicine or any other somatic treatment is not evil but a blessing. This is to be done in a very sensitive way so that their sentiments are not offended, otherwise the patient is let to rot in a room and denied the quality of life. This might sound alien to people who are not exposed to these situations. What are you talking about, doctor? In this modern day and age, nobody treats people with mental illnesses like that. No, the grassroots level is not apparent to the real world. In a village, if someone develops a mental illness, it is still a taboo that is tried to be covered up. They are ready to let people know that their son/daughter is affected by some sort of ghost/black-magic but not by the imbalances in their neurotransmitters.
It looks like such a simple thing, when you suffer from an illness, you seek the specific doctor; yet it is not so simple in Psychiatry. I, then got down to the grassroots and tried to educate people in masses. Attending community level camps, school events, social events and what not. Finally, in order to reach the masses in huge numbers, I got into their palms and started speaking (who doesn’t have a smartphone in their palms?). There lies another problem ; they can’t listen to you for more than a few minutes or even few seconds (because reels! Duh). So, I started condensing the content and made it available in the easiest language in the shortest time. This gets better reach. They are able to relate to the content and are able to break out of the stigma and reach the Psychiatrist’s office (at least a few of the lot).
There lies the same issue, why medicines? Why not counselling?
About 100 years ago, if you started having a psychiatric symptom, you were banished from home & society. You were not given equal rights as any other human being. There was no cure. There were no medicines. These were human subjects on whom unethical experiments were conducted. Such was the state, but with the advancements in medicine, the condition changed. There was a possibility that these patients who behaved like aliens could behave like any other human, could live like any other human, if not an extraordinary life of achievement but a life worth living. This was possible because of the medicines. They were not evil, they were a blessing provided through scientific advancements. Another misconception is that counselling or psychotherapy is just talking. It has some scientific principles too. And there are specific indications for Pharmacotherapy and specific indications for Psychotherapy and some for combined approach. Why am I rambling about all this here instead of in the reels or articles to reach the general public? Because no matter how many times awareness content is posted regarding this, I have to repeat this entire script to every patient that walks into my clinic assuming talking is curing. This takes a major chunk of my time which can be otherwise spent in treating the patient, reading evidence for the patient’s betterment or even providing therapy for the patient and obviously having a cup of coffee for myself.
Despite posting awareness content and reels with a good intention, what do we get back from social media? “Why not answer our problems in the comments section or in the DM? Why are you so evil that you are asking us to pay you and get consultation for this?” This, Ladies and Gentlemen, is how we are dealt with on Social Media.
This is how Psychiatry at the grass roots is. (Written from personal experience and observation).
References:
- Murthy RS. National mental health survey of India 2015–2016. Indian journal of psychiatry. 2017 Jan;59(1):21.
- Kartheeka DrMG. Understanding the state of Mental Health in India [Internet]. 2023 [cited 2024 Feb 10]. Available from: https://pharmeasy.in/blog/mental-health-illnesses.
- O’Neill A. India: Literacy rate 1981-2022 [Internet]. 2024 [cited 2024 Feb 10]. Available from: https://www.statista.com/statistics/271335/literacy-rate-in-india.
- Braslow JT, Marder SR. History of psychopharmacology. Annual review of clinical psychology. 2019 May 7;15:25-50.
