Leading them out from the dark

The issue of mental health has never been so much in the limelight as in recent weeks. In the mental health care scenario today, it is all in terms of Before Erwadi and Post Erwadi.

Though not so much in the limelight, Dr. M. Soundararajan, who escorted the Erwadi patients along with Dr.Sukhadev from Ramnad to the Institute of Mental Health (IMH) Chennai, wears many hats. He is assistant professor of psychiatry, IMH, secretary, State Mental Health Authority and co-ordinator, District Mental Health Programme and was among the team from the Institute of Mental Health that studied the situation at Erwadi after the diarrhoea deaths were reported.

He speaks passionately to Ramya Kannan on the need to spread awareness on mental health issues.

THE SCIENCE of mental health is relatively `young', Dr.Soundararajan feels. Probably one reason for the misconceptions about mental health and lack of awareness that most mental illness, like physical illness is curable.

``Problems of mental health are as common as problems with physical health. While major illness (psychosis) affects approximately one per cent of the population, minor illness (neurosis) affects nearly 15 per cent of the population'', he begins. But if that sounds alarming, the doctor assures immediately, ``It is not as bad as it sounds. Most people suffer from anxiety, depression, obsessive and panic disorders. And they might be able to manage well on their own, without medical help''.

`Stigma' is one word that psychiatrists often use and R.Soundararajan is no exception. The `stigma' of having persons with mental illness in a family is enough to convince relatives to commit acts that they would otherwise not even contemplate- like `dumping' the patients or ill-treating them. Mental illness then, is a more debilitating disease, more so because of the isolation of the patient from the rest of an erstwhile loving family and the community. And according to Dr.Soundararajan, it is not an `Indian phenomenon', even the WHO has called for a focus on removing stigma.

The District Mental Health Programme in Trichy focuses on spreading awareness, among other things. The programme will also be started in Ramnad and Madurai soon. At Tiruchi, the programme which has run into its fifth year, has been a success, going by the number of new patients who have sought medical help for mind related disorders. ``It is a measure of success that around 2700 new cases and over 42,000 cases have come in for review''.

Another issue that has been agitating the public consciousness it that of `faith healing' centres. Give the credit to Erwadi again. ``A combination of ignorance and the constant search for remedies takes people to faith healing centres'', he says. Some mentally ill patients tend to run a `chronic' course at some point in the illness and may improve, but ``certainly not without medication''.

During these `chronic' phases, patients may be violent or seem uncontrollable. Then, relatives are unable to reconcile themselves to this condition and keep searching for remedies-that is when they turn to magic and miracle.

``People do not seem to realise that everywhere treatment for mental illness is nearly the same, though approach may be different. And that the `chronic' phase has to run its course''.

The search for THE CURE takes them to faith healing centres, what many people see as a last ditch method.

A number of patients at the Gunaseelam temple in Tiruchi and the dargha in Goripalayam have claimed that they have been cured after the mandatory 48 day stay in the temple. The belief that faith works even when medical science fails, is borne out by instances of people with a long stint in mental hospitals recovering from their illness after a brief stay at these faith healing centres.

``We do not dispute that faith cures- faith is a helpful adjunct to treatment. But patients must take medicines during the period they stay in the faith healing homes'', Dr.Soundararajan explains. So, how does science explain the miracle `cures' that are claimed at some of these faith healing centres? It seems simple enough when he says, ``These disorders run a fluctuating course. Sometimes, disturbances naturally set themselves right after a period''.

If you ask him for a one-line mantra, Dr.Soundararajan says ``Do not fear the mentally ill and shun them''. The experience in bringing the patients down to Chennai was enough to convince the public that mentally ill people were not `unmanageable'. Apparently, the journey to Chennai was uneventful and the patients all co-operative, though most of them were not under drugs. He says with conviction, ``If only you are prepared and know what to do, you can handle even the really violent with ease. You do not have to hide them or be ashamed of them''.

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