DepressionRajan, a middle aged executive was working in his office, when he felt a congestive feeling in his chest. Fearing an impending heart attack, he was rushed to hospital. He was put through a series of tests after which the doctors declared he was perfectly well. The tests results were normal. However, he experienced the same symptoms a second time within a short span of time. Again the doctors could not diagnose anything related to the heart.
Sheila, a housewife, was working in her kitchen when she fainted one day. She was promptly taken to a doctor. She too had to go through the usual rigmarole of tests that were recommended. However, the tests did not provide any pointers to what her problem really was. Things slipped back to normal for some time till she began to have fainting spells again and again. However, in her case as well, doctors could not diagnose what her problem really was at that stage.
These are examples of what is termed as “Problems of living” or “Minor psychiatric illnesses”. Dr. Dattatrey Dhavale, a practicing psychiatrist in Pune says, “Most of us do not associate the illnesses we have with our mental state. There is a very strong mind–body link. In the above cases, physicians could not diagnose anything although the symptoms were real since the problem lay in the mind and not the body”. He added, “Unlike in the West where people are better aware of their emotions, Indians are not that much in tune with themselves. They do not spell out their emotional needs and rely heavily on fate. English soap operas beamed on TV are to an extent a reflection of society there. A dialogue such as, “Give me a hug or I want your support”, is common in the West while it is unlikely that you would see something similar in an Indian serial”, points out Dhavale.
Dr. Dattatrey expressed the view, “Indians express stress in a physical form as it is more acceptable, than actually admitting the fact, perhaps verbally, that they are under stress”. These physical symptoms are termed as “Cry for help”. It could be headaches, giddiness, palpitations, pain in the abdomen or feeling fatigued”. In the example referred to above, the man was actually depressed because he had lost his wife and was not able to grieve openly. Similarly, Sheila who was a housewife in a joint family was under tremendous stress owing to her differences with her mother–in–law. Nobody showed any sympathy or empathized with her if she complained. Moreover, what made matters worse for her was that her husband was not too supportive or understanding. Unable to give vent to her frustrations, it showed up as fainting spells. This got her the attention of all around her in the family, and she is now looked at with some concern.
Dhavale opines, “If the family knows there is no immediate danger to an individual’s life, they tend to ignore it, and the problem is not treated by a psychiatrist either. Since the basic problem is not resolved and goes on for years, all the pent up frustration is then like a pressure cooker waiting to burst. The individual then begins to get depressed or begins to harbor suicidal thoughts. It is only when life becomes unbearable that people go in for counseling”. The fact that approaching a psychiatrist is stigmatized in our society also acts as a hindrance. Dr. Dattatray feels that most Indian men do not understand or have an insight into women’s psychology. Most of them are at a loss trying to understand why their spouse is unhappy in spite of their being provided with all material comforts. They fail to understand their need for emotional fulfillment.
Most patients reject the suggestion that their ailments are psychosomatic in nature. However, Dr. Dattatray stresses their ailments are very real and that the cure lies in their own mind. Other obstacles that have been pointed out in treating patients with minor psychiatric problems is that specialists are approached directly without any reference to or by a general physician. A consultant then looks at the complaint in isolation. The old system of having a family physician seems to have gone out of vogue. The family physician knew the family well and could pinpoint if any particular ailment was due to stress.
If the root of the problem is identified and treated, then the symptoms are likely to disappear. As in the case of Rajan, once he was treated for depression he became completely normal. He did not have symptoms similar to a heart attack again. In other cases, the solution may not be so simple unless the cause of stress is not removed. In a joint family scenario it could be the moving out of a couple or the husband being more sympathetic to his wife’s woes. Whatever the problem, a greater awareness of the mind-body link and better self–awareness will go a long way in solving the “Problems of living”