Introduction to Mental Illnesses and Psychological Problems
(This article written by Dr. Aftab Khan, appeared in The Review, Dawn Newspaper June 17-23, 1999)

One of our professors in medical school often said of headaches, “if you have a head you will have a headache.” After years of studying, teaching and practicing psychiatry, I have come to a similar conclusion about the human mind. That is to say, “if you have a psyche (mind), you will have psychological problem.” No, I am not Mr. Murphy, nor do I want to apply his pessimistic view to our minds. The point is that such issues are widespread and they affect us all in varying degrees at some point in our lives, whether we consciously recognize them or not.

The purpose of this article is to create awareness and clarify many myths that exist in our society about mental illnesses by providing medical and scientific facts. Education allows many to move beyond myths claiming that the mentally ill are possessed by djinn, bhoot or churail. A great majority of people in Pakistan, particularly in rural areas, believes in this supernatural phenomenon. People, who are more educated, however might have different kind of myths, some of which are listed below.

Myths

• Mental illnesses are uncommon; being mentally ill means being insane, acting in strange ways and probably thinking bizarrely.
• Psychiatrists treat insane people and one has to be crazy to go to a psychiatrist.
• Psychiatrists themselves are absent-minded and half-crazy.
• Being mentally ill is a sign of weakness; strong people do not suffer from mental illness.
• One can fight mental illness by will power.
• The more one thinks of a mental problem, the worse it gets, so the best way to deal with it is to keep ignoring it and reassuring oneself that everything is fine.
• The basic idea of psychiatric treatment is to sedate the insane person with medicine (hence the name “tranquilizers.”)
• All psychiatric medicines are sedating and habit-forming so the patients have to take them for the rest of their lives.
• Being mentally ill means being a loser in life.
• Most people who complain of psychological symptoms are either attention seeking or want to avoid their responsibilities, and they improve when mocked and ridiculed.
• Children cannot have a mental illness or psychological problem.

Research
Psychiatry and clinical psychology attempt to medically and scientifically study mental illnesses and treat them. In this century, particularly in the last four decades, enormous advances have been made in these fields. Billions of dollars have been spent on research in the US alone. Elaborate studies are designed, planned and then conducted in large teaching hospitals with a staff specially trained in research methods.
SPECT and MRI scanners are used when needed to look at different parts of brain and their functions. Some idea about research work being done in this field is useful because it leaves little room for myths or misconceptions. One starts to see mental illnesses as tangible and treatable problems, rather than explaining them in amusing ways, which cannot contribute towards a better understanding and sound solutions. Sending a man to the moon was once a fantasy but it was achievable because it was approached in a scientific manner, with all the steps outlined and backed by experimentally proven data. Scientific objectivity enables any group of people to repeat a task if all the steps are followed. This also holds true for understanding and treating mental illnesses.

How common are Mental Illnesses and Psychological Problems?
The prevalence of mental illnesses and psychological problems depends on the criteria applied.

Criteria 1
Anyone who has been emotionally upset for some time for any reason and could have benefited from psychological treatment, then he or she is considered psychologically disturbed.
All of us at some point in our life would meet the above criteria. Based on this then 100% of people suffer from some kind of psychological problem. To make an analogy, how many of us can go through life without ever having a dental problem? Or a headache? That is why a great majority of individuals can benefit from counseling for emotional or relationship crisis they repeatedly fall into without realizing it.

Criteria 2
A person can be considered mentally ill only when he becomes completely insane, loses touch with reality, utters weird things and acts in bizarre ways (psychotic illnesses).
According to global epidemiological studies, the chances of developing psychotic illnesses are about 2 per cent. In other words, one in every 50 individuals is likely to suffer from it in his or her lifetime. In our society, only such extreme conditions are labeled as mental illnesses. For non-psychotic conditions like depression and anxiety, people avoid seeking help, no matter how much they suffer because they fear being known as crazy or believing that nothing can be done about it.

Criteria 3
All psychiatric disorders that are listed in the Diagnostic and Statistical Manual for Mental Disorders published by American Psychiatric Association. Which means that a person is considered to have a mental illness only if the symptoms of his condition meet the full criteria for the diagnosis of any particular disorder.
Based on these criteria, epidemiological surveys in USA reveal that one-third of all Americans will have, a psychiatric disorder at some time in their lives. The most common mental disorder is anxiety, the next being depression and drug abuse. It is important to realize that drug abuse also includes regular use of sleeping pills (Lexotanil, Valium, Ativan, etc.) that most people use without a doctor’s recommendation. There are no good studies for Pakistan but the numbers here would probably not be much different. Some studies done in here have revealed in fact higher incidence, especially among women.

When is the best time to consult a mental health professional?
The easy answer is when in doubt; one should see a mental health professional for an opinion. In our society, such consultation is stigmatizing and is mostly avoided. There is more awareness in the west. For example, at Harvard University, Boston, USA, 33 per cent of the students consult the mental health service. They realize that looking at their emotional difficulties together with a mental health professional only adds to their personal strength.

The following indicate some of the common problems for which psychiatric help can be very beneficial:

Most people are uncomfortable with the thought of mental illness. If one has a physical health problem, it is much easier to reveal and discuss with others, as the most common response from other is that of sympathy. On the other hand, mental illnesses are embarrassing and the attached social stigma is such that many live alone with their emotional pain and share it with very few. It is hard to give a good explanation for this universal phenomenon, but simply speaking, our mental capacity is the only advantage we have over animals. Problems with mental functioning probably make one feel subhuman. Even though mental illnesses do not spare anyone on the basis of cast, color, religion, education or wealth, of one thing I am sure; they do not make people less human. Sir Winston Churchill, Abraham Lincoln, Vincent Van Gogh and Princess Diana are only few examples of people who suffered from mental illnesses.