A Humanistic Approach Towards Mental Illness

Masterly perspective on the issue Dr. Sohail!

I don`t thhink that the people with schizophrenia, for example, are capable of grasping the concepts such as, ``respect``. I think their mental faculties cannot even conrol their biological selves very well. My contention is purely academic and should not be construed as that the mental patients are fair game for anyone. My contention is that common people should be educated to treat them differently from ordinary human beings. For example, the concept ``respect`` has reciprocatory connotations; and if we educate a common citizen to give ``respect`` to a schizopherenic, then practically it would amount to nothing, except frustration. On the other hand if an ordinary citizen is educated to be humane to menatl patients then its would be more productive since being humane has no reciprocatory connotations.

As far as ``respect` to schizophrenics is concerned our culture do promote the concept of ``Allah lok, or SaiN Lok``, which at least helps them survive. But I think it must change.

Re: # 2
dear urstruly...thanks for your ideas about `respect` and `humane`. keeping semantics aside

in my opinion both attitudes overlap. i agree with you that when someone is sick they

need to be treated humanely and not expect a reciprocity but when their symptoms are in

control and they are functioning well then mutual respect will be a realistic expectation.

I have a few schizophrenic patients who are doing so well that their colleagues do not know

they see me and take regular medications. Sometimes such patients suffer because of

the prejudiced policies of the organizations. Humane treatment of psychiatric patients would

be a great social achievement and can be achieved with education.

...sincerely sohail

Dr. Sohail,

I think what Mr. Urstruly means in #2 is that perhaps “dignity” would have been a better term than “respect” in the sense that you have used in this article.

The article itself is generally good, in spite of its coursework like layout. I think it would have been a little more interesting and useful had you focused on more of real life cases (of the type you started the article with).

In the sub continent, the statement regard the very much lacking state of mental care is applicable to the field of medicine in general including such areas as eye care, dental care, general cholesterol levels, etc.

The societal class consciousness also affects the medical community – often the poorer patients get scant attention. There is also a tendency to take the “Doctor knows best” line – both among the doctors and the patients – and medical questioning is discouraged. This reduces the benefit of feedback and also can make the doctor overly sure of himself and less willing to keep up with the latest research.

Needless to say, in the sub continent many times depression is not recognized for the serious physical disorder that it is. Perhaps there are countless numbers of suicide cases that could have been prevented had medical intervention taken place in a timely manner.

However, in general desis tend to talk more openly among themselves (with family members and friends) which perhaps provides some of the benefits of psychotherapy automatically – something that the Westerners have to pay for.

The attitudes are changing now. People are less reluctant to get psychological evaluation for their family members. In general, awareness of healthy practices has increased. I think that at least in the urban middle class, the younger generation gets better care and nutrition and is showing its effect, in spite of some of the new unhealthy habits (like junk food).

Re: # 3

Another great article, with valid points. As somone who works with several types of mental illness, I also think that `respect` and `humane treatment` overlap, to the extent that they are much the same thing. To treat somone humanely you need to respect their basic human rights.
There are so many misconceptions about those with mental health issues, and I have not seen the attitudes change much. Only recently did somone gasp on hearing that I work with a schizophrenic who is breaking down and ask, wide-eyed: ``But isn`t it dangerous?``

More education work is needed, and more outreach work to educate those from a different background (ie. those from a different culture to the host counrty) about these disorders.

(A field of work that I want to break into).

Re: # 4 bjkumar, you have raised a valid point - there is a stronger sense of community and family in certain cultures, which is very healthy. But alas a lack of knowledge and recognition of symptoms means that, according to one study (forgive me- I can`t remember the details), it found via annonymous questionairres that the rate of depression in Asian middle aged women* was three times that of a comparable group of western women. Possibly because of a lack of understanding, less willingness to seek help, and less resources for them.
This made me sad (ironic really).


*living in the UK.

Re: # 4
dear bjkumar...it is interesting that you raised a significant isuue of the differences between

urban and rural areas and between different classes. Urban middle class is more educated

and have more services available to them. In those countries where majority of the

population in villages with minimum education there is more tendency to go to holy shrines

for physical and mental problems rather than seeing nurses and doctors who are

unfortunately scarce. even in the West rural areas are less serviced. progressive

governments provide...unattractive area allowances.... to attract doctors and nurses. in

canada they used to ask foreign doctors to work in rural areas for three years to qualify for

immigration. i do not know whether that rule still exists or not. sincerely sohail

Re: # 5
dear abskii....transcultural mental health is the field of the future. if you pursue that, it

would benefit a lot of people and hopefully you will also learn a lot. these days i am working

with such a group in toronto. i and my friend rafiq sultan just finished translating a 100

pages mental health guide in urdu for urdu speaking immigrants from india and pakistan

such education is vital to raise social consciousness and reduce human suffering. thanks for

your keen interest in my article....sincerely sohail

Not only non recognition of mental illness but many patients seen by general practioneers are Psychsomatic.
The cultural problems in Indian SUB continent for people living there not with holding when elderly or less sophiscitated population like in Brad ford, Birmingham England Imigrants encounter FOREIGN set of rules there is bound to be Psychosocial upheavel in the form of crime Depression violence and may be some of the problems in U.K.

[....When I lived in Pakistan I used to see half naked mentally ill people walking around aimlessly on the streets...]

Hey doc, you dont need to go to Pakistan to treat mentally ill people. You have the perfect patient waiting for your help right here in the US - Mr. Behram Atashband, aka Retardo aka Austin waley Bawaji. He badly needs your expert attention as soon as possible. I have never met a bigger cuckoo than him.

Of course, there is also the possibility that after trying to treat him you may go insane yourself.

#10 Ranjit

Yaar, but I think you guys need to stop provoking him, too!

Re: # 10 by ranjit on December 8, 2006 6:53pm PT

{Hey doc, you dont need to go to Pakistan to treat mentally ill people. You have the perfect patient waiting for your help right here in the US - Mr. Behram Atashband, aka Retardo aka Austin waley Bawaji. He badly needs your expert attention as soon as possible. I have never met a bigger cuckoo than him. }

Actually, you yourself are the biggest fucked up Hindoo bharwa on this chowk.

{Of course, there is also the possibility that after trying to treat him you may go insane yourself. }

Just worry about your bipolar and autist hindoos who have infested this chowk.

You are just a myopic, delusional hindoo bharwa, that all

Do mad people evoke `pity` or do they evoke `empathy` in us?

Pity is condescending, an ugly thing in disguise.
Empathy has been defined as `appreciation of the other`s inner feelings`.

We hope DrSohail`s humane-treatment motivation is empathetic in origin :)

Yet, how can we be empathetic when we don`t know (or are scared to know) the madman`s inner feelings???

Perhaps in this forum DrSohail can draw on his experience and tell us about the `inner
feelings` of his patients.

What is it that classifies a person as insane? His thoughts?

#13 by HD on December 8, 2006 10:14pm PT:
{Yet, how can we be empathetic when we don`t know (or are scared to know) the madman`s inner feelings??? }

Read up on the effects of the disorder, and imagine trying to live your life through that - like wearing somone else`s shoes. I did hear of an awareness course that, whilst the group was being taught about the subject, a person whom they had been instructed to ignore was creeping about and whispering in their ears, spraying perfume or peeling an orange, or tapping on their shoulders. If they reacted to the stimulation they were pointed out to the group. Try to imagine that, and try again in public.

Schizophrenia is like looking at life through a broken window - fragmented and distorted. (Hence why the majority of schizophrenics are withdrawn and insular, rather than homicidal).

Dr Sohail, this is a good article; I might actually print it out to give to patients families at some time, if ok with you.Thanks.

Re: # 15
dear nb....you are more than welcome to share my article with anyone who might benefit.

they can find more articles about mental health in englsih and urdu on my websites

www.drsohail.com
www.greenzoneliving.ca

thanks for appreciation....sincerely sohail

Re: # 13
dear HD....your letter is anspiring me to write another column about schizophrenia

and depression in the future....thanks for the inspiration....sincerely sohail

Re: # 9
dear tolkinin....i agree with you that many patients who go to family doctors with physical

symptoms have psychosomatic problems and their emotional problems and stress of life

are contributing to their high blood pressure....peptic ulcer....migraines...and many other

physical symptoms....the more family doctors are becoming aware they are offering

emotional support and consulting mental health professionals. such problems are also seen

in immigrant families who are trying to cope with the stress of cultural

integration...sincerely sohail

#16
There is ignorence or double mind about Psychiatry EVEN IN THE WEST.The most unknowledgeble TomCruise goes about preaching so called Scientology and denying about psychiatric illness.The National Alliance of Mental Illness advocate of psychiatric patients have done a lot here in USA no doubt ,it is even estimated that more than half of prison population are there because of lack of treatment of there bIpolar or juveile delinquency of Adolescent Psychiatry .But yes the problem is more pressing in India where medical conditions like Squint,Hunch back (Scoliosis )and any Medical illness is DEMONISED.

Re: # 19
dear tolkinin....i agree with you that even in the enlightened west there are illinformed

social and religious organizations like church of scientology who misguide people and

create hurdles in people making wise choices about their lives and getting help to decrease

their sufferings....sincerely sohail

#20 I agree with you for bringing attention to very important apect of human maladies which is either denied or unrecognised because of ignorence.
In no way i am taking side or defending practices anywhere

abskii,
I think you might be mistaking `hallucination` for `insanity`. Hallucinations are reported by drug users, meditating yogis and even by people `madly in love` (pardon the pun). Hallucination may be part of the effects that insanity brings, but by itself is not unique to insanity.

>>Schizophrenia is like looking at life through a broken window - fragmented and distorted.
You`re just quoting someone, aren`t you :)
Or do you actually know what that means? - looking at life through a broken window

#22
Hallucination,Illusion & Delusion
Agree with you Hallucination is symptom and not disease itself...three classic symptoms of mental illness are hallucinating which is imagining things which does not exisist....Delusion is of Ideas that are irrational thaught,like thinking of one self as President of country And Illusion which is Mistaking a Rope or other Exisisting object as Snake in case of Rope.

Thaught
Feeling
And Action is distorted in Schizophrenia

Dear Dr.
Particularly in Pakistan the most part of the urban and rural society are mentally ill, the reason is not the poverty, Mental illness is no myth, as some have claimed. It is a disturbance in our sense of possession of a stable inner self that survives its personae.
Ahad

Re: # 24
dear ahad...you are right mental illness is not a myth. it is a reality for people who suffer. i

believe education, proper health care and a compassionate and humanistic attitude can

decrease that suffering. thank you for your wise comments...sincerely sohail

Re: # 22
HD, I never said it was unique to `insanity` - it was just an example of what these people cope with (or try to). I know a few people who experience auditory hallucinations/disturbances as part of a stress response.

And I was not quoting anyone (to my knowledge) - it`s just similar to how one of my clients described it once.

Hi Khamkwa!

One of the most disturbing images I remember growing up was a mentally disturbed woman completely nude standing at a busy traffic signal near Sion in Mumbai. I was maybe 12 at the time and my adolescent brain`s first instinct was to laugh loudly and point. But I saw the looks of utter horror on my parents` face, and my Mom said a small prayer for whatever horrific circumstances had provoked the woman into behaving the way she was, praying for her safety from evil misguided elements- and I knew there was a lot of pain there. I still remember that image vividly and wonder what happened to that poor woman.
Mentally ill people probably are the worst affected in this cruel society of ours. At least in the case of physically handicapped people, while we make life as difficult for them as possible, there is some acceptance that they may lead useful lives (e.g. blind people selling lottery tickets and running STD phone booths in India); with ``paagal`` people, we even deny that dignity.
Two cases I can think of- one of my close friends growing up: he and I were in the same class and lived a few doors apart. His mother died when he was 5 and the rest of his family (Father, 2 elder sisters) never really filled the void in his life that the loss of his mom created. The sisters were both much older than him and had their own lives to lead; the father was in permanent denial and refused to act even when the young man`s tales of horrific cruelty were brought to his notice- to animals (he used to freeze live cockroaches in bowls of water) and to his friends (he once jammed my finger in his front door and refused to open it; my cries brought down my Mom who had to open the door- I still have the scar). He had a violent temper and getting into a fight with him was a potentially life-threatening situation.
Those of us who grew up with him knew an other side to him- he was a brilliant skater and cyclist, and had a sharp wicked sense of humour. He also had excellent taste in music- most of the stuff I heard growing up was at his place (perhaps to make up for the lack of attention, his father never scrimped on the pocket money, unlike my own parents). We also watched a lot of our ``coming of age`` movies on his VCR because that was the safest place to- there was never anyone home.
He seemed to mature as he grew older, but it was an illusion. His father died in his late teens and after that there was just no hope for him. He got hooked on drugs- always lean, the habit left him a gaunt shadow of his former self. He stopped being social and the nieghbourhood children, instead of fearing him as before, now looked at him with amusement and some disgust. He had but one friend- a girl who used to visit him often and eventually started living with him; they probably did drugs together. I never lived at home much after I was about 21, but I`d bump into him on the stairs sometimes and he`d always say a tired hello. Conversation would be awkward because we didn`t have anything much in common anymore- the most we`d do is enquire about common friends and then uneasily go on our ways.
He took a big leap off the terrace when I was away at b-school and fortuitously landed on my dad`s aluminium ledge- the 3-feet wide sheet that protects our balcony from the rain. He rolled off it to safety and escaped with a thoroughly bruised back. He claimed it was an accident- that he was trying to adjust his TV antenna and slipped, but at 4 in the morning, and with his background, he had few believers. My dad grumbled about the cost of a new ledge, but we all feared the end was not far away.
He finally succeeded at taking his own life by hanging himself on the fan in his own bedroom. The maid who came a few times a week found him and had a screaming fit. His sisters turned up and took care of the funeral formalities. They put the home on the market, but found no takers for quite a while- who wants to live in a house where someone killed themself? Eventually someone saw the practical side of it and bought it at a much cheaper rate than market; he moved in and as the years passed, the unease passed as well. He`s well-nigh forgotten now, except if one of the neighbours mentions him as an example of a kid gone- horribly- wrong.
What happened to the girlfriend was never very clear. She was never seen again. Unconfirmed rumours said that he killed himself because he`s found out he had AIDS, probably from the drug use. The last sordid chapter in his desperately miserable life.
I am pretty sure he was seriously mentally ill- perhaps if his family had seen what was so obvious to us a little earlier, or perhaps, like my Mom says, `if that child had got just a little more love`, he would have still been around, zipping around on his bike, inviting us to watch movies at his place. I don`t know. I don`t even know why I am writing all this here. Just that the article triggered something that must have been buried deep inside.
RIP, my friend.

Re: # 27
dear delhiwala....are you confusing me someone else...known as khamakha? thanks for

hello anyhow....sohail

Re: # 28
dear burpinder...if my article inspired you to write such a sensitively written wonderful

letter, i take as one the best compliments. i saw my father having a nervous breakdown

when i was a boy of ten. he had to receive shock treatment. he recovered and a man who

was a mathematics professor and a freethinker adopted a saintly lifestyle. now i have

started writing a book about my own encounters with mental illness professionally as a

psychiatrist as well as personally seeing my family struggle with it. i am also collecting

stories of other people for my next book. can i use your letter for my next project?

sincerely sohail

Re: # 30

Yes you may by all means. It`s my privilege :)

abskii, ok no offense meant :)

But just for interest, what can this possibly mean - Looking at life thru a broken window.
I`ve also heard/read this in several places. So it must have a meaning, to someone.

We can rule out vision problems. That would be silly.
The schizo sees things as clearly as anyone else.
so what can it mean `Looking at life thru a broken window`.

Is it perhaps, an inability to figure out (make sense) of worldly relationships?
Like when we see a bus, tree, another human or animal, we know its exact (or fairly exact) relationship to us (which is what we most care about).
So we`re not overly excited/anxious about, say, seeing a cat.

And Schizos do exhibit this charactersic - an inability to evaluate a situation `normally` (`normal` is loaded I admit!).

But that still doesn`t explain - Looking at life thru a broken window.

I think there`s something else.
This inability to evaluate a situation normally is only a `side effect`, I think, of something else.



On another note, there is this fad of `expansion of conscious`.
Drug users and various meditation techniques (TM etc) promise us an `expansion of our conscious`, all for a few dollars off course :)

What they mean is, a greatly enhanced `sense of existance`. One sees colors and smells more vividly. New relationships are seen where earlier there were none. Creativity blooms. A happy, secure feeling pervades.

Now is this a reasonable question to ask - Can there be its opposite - a `contraction of consciousness`?

Re: # 5
Abskii, what do you do??

Christmas carol by Psychiatrically challenged:

SCHIZOPHRENIA:Do you hear what i hear ?

MULTIPLE PERSONALITY DISORDER:We three queens Disoriented are

DEMENTIA:I think i will be home for Christmas

NARCISSISTIC:Hark the herald angels sing about me

MANIC:Check the halls,and lawns,and walls and steerts and stores and stores and office and town and cars and busses and trucks and trees and fire hydrants

PARANOID:Santa Clause is coming to get me

OBSESSIVE-COMPULSIVE DISORDER:Jingle bell Jingle Bell Jingle bell rock Jingle bell Jingle ......

you make it sound like we may not need the mental health ordinance to be implemented to achieve the same purpo se in Pakistan.that is the right to live a normal and dignified life for a person going through or recovered from a mental upset. if awareness and empathy for the mentally ill could be developed in just aday! how is it possible to reach so many people and meanwhile the mental sufferings go on. adding to the physiological sufferings which a human bein` has to undergo anyway. a mentally ill person negatively controls the lives of those close to him.then tell me will the MHO be redundant in our hands?

Re: # 35
dear foggy....i am feeling a bit foggy after reading your letter. living in canada for the last

30 years i am out of touch with recent developments in pakstan...can you share with me

what is MHO....?

i am in full agreement for doctors and nurses to educate families and treat people who

need mental health services...it is an uphill struggle but worth it. are you involved in health

care services in pakistan? what is your experience? sincerely sohail

sorry, did not mean to make you foggy`. canada is a beautiful country. so coming down to the ornery scenario...mho simply stands for the mental health ordinance pakistan, which has been around since 2001. it is SUPPOSED that when it is Implemented-then mental patients will get their due protection. concerned people like the mental health staff, and the families of mental patients, the mental patient if educated enough, and the citizens of pakistan;allwill have a platform, where they will find their voice, and have their say, and be heard. me, i am one of the concerned citizens. i think your views on the dignity and quality of life of the mentally ill are gentle, good and ``humanistic``.

Re: # 37
dear foggy...thanks for the clarification. i am glad we are on the same wavelength....sohail

Dear Dr Sohail!

u have explained a lot abt mental health problems and about their awareness in community, but there is one querry in my mind d even if a person is personally aware of mental health process, there are poeple in our society who r literally playing wth the minds of people. dont u think d the way a therapist develops a step by step relation with client for therapy, the same way that relations should be resolved at the end of therapy? and if due to the incapability of therapist, therapist breaks the relation during some crisis completely(when the bonding of client with thereapist is at its peak), then in that case where would d shattered client go?

could u plz put some light on this issue? and in case how do a client can come up with this double crisis?

Re: # 39
dear smile 22....you have asked a very important question. it is a serious crisis for a client

to feel betrayed by the therapist. i have met a few patients in my life who felt betrayed by

their therapits. i had to work hard to gain their trust and help them realize that all therapists

are not the same. it is similar to those children who feel betrayed by their parents and

teachers. it is hard for them to trust authroity figures in the future. i feel the same

principles apply to social and poltical leaders of organizations, institutions and states.

but i am optimistic that when persons, families and communities realize the problem they

can solve it by choosing a therapist or a leader they can fully trust and who is worthy of

their trust and can guide them to solve their problems...thank you for asking such an

insightful question...sincerely sohail

Re: # 39
dear smile 22....you have asked a very important question. it is a serious crisis for a client

to feel betrayed by the therapist. i have met a few patients in my life who felt betrayed by

their therapits. i had to work hard to gain their trust and help them realize that all therapists

are not the same. it is similar to those children who feel betrayed by their parents and

teachers. it is hard for them to trust authroity figures in the future. i feel the same

principles apply to social and poltical leaders of organizations, institutions and states.

but i am optimistic that when persons, families and communities realize the problem they

can solve it by choosing a therapist or a leader they can fully trust and who is worthy of

their trust and can guide them to solve their problems...thank you for asking such an

insightful question...sincerely sohail

Dear Dr Sohail
if u don`t mind, reading ur philosophy towards life and humanity in general, I am curious to see u personally, would you mind telling me some easier and practical way to meet you?

Dear Dr Sohail
if u don`t mind, reading ur philosophy towards life and humanity in general, I am curious to see u personally, would you mind telling me some easier and practical way to meet you?

Re: # 43
dear smile 22...i practice psychotherapy and live in a darvesh`s hut in whitby ontario

canada, close to toronto. my dear friends, the artists, mystics, poets and philosophers meet

every sunday in darveshon ka dera. you are more than welcome to come anytime. last

month mohammad gill (who i knew through chowk.com and never met) came to see us and

we had a wonderful lunch and discussion. we put the details of our meetings on my website

www.drsohail.com

where do you live?

you can also welcome to write to me

welcome@drsohail.com

thank you for your sincere interest....sincerely sohail

Dear Dr Sohail
thankyou for your generosity but this recipie is good for those who are in canada, what about those who can`t come to canada?????????

smiles

Re: # 45
dear smiles..then you can invite me for a cup tea with directions to your home...where do you live? sohail

Dear Dr Sohail

OH Great!!! so wen do I am able to see u??? in pakistan

smile22

Re: # 47

dear smiles22...23...24...did you see my interview in surkh chanar magazine of lahore,,,if not you can see it on my website...
www.drsohail.com
My book...Love, Sex and marriage
is being published again in India.
I and my Canadian sweetheart Bette Davis are planning to visit India and Pakistan in Decemebr 2007. what city do you live in? My sister lives in Lahore...thanks for the invitation...how did you pick the name smiles and why 22 not 26...sincerely sohail

Dear Dr Sohail

I think I am a very lively person thats why i have put my name smile over here, and 22 is my date of birth.
I have read your article in red channar but the philisophical issues u discussed in it are beyound my level so i cant comment on it, however I am curious to read ur book abt love sex and marriage because it is the ultimate end of a girl in our society. Is it available in pakistan or tell me ur publishers adress and i will get it.

currently i am in lahore however my husband`s transfer is expected during this year so i can`t say where i will be at the end of year. you have set the timeframe for meeting me like the westerners put expected marriage at the end of year and the remaining time lapse for understanding between persons.

anyways best of luck

smile22

Re: # 49
dear smile 22....i will ask my sweetheart and co-author bette davis if she can find me the PDF file of our book so that you do not have to buy it and i can send it my email. please write to me at
welcome@drsohail.com
if you wish to have a copy of the book
i like your sense of humour....sincerely sohail

hi Dr sohail

u can mail me at smile22_2007@yahoo.com

thanks
smiless