The Pill and the Mind

Alok Bajpai

India’s doctors increasingly use pharmacological solutions to treat mental health issues, but that may be leading us down the wrong path

 

“[T]here is always soma, delicious soma, half a gramme for a half-holiday, a gramme for a weekend, two grammes for a trip to the gorgeous East, three for a dark eternity on the moon...”– Aldous Huxley 

 

Alok BajpaiA few years ago, the World Health Organisation (WHO) projected that by 2020, every fourth Indian would be on antidepressants or anti-anxiety medication. The statistic got revised when the WHO declared that 7.5 percent of Indians suffer from mental illnesses. The real figure may be higher if other illnesses are added by strict clinical criteria. Cases of depression have been rising at 18 percent globally, and it’s now considered to be the number one silent killer. In India, the 2016 National Mental Health Survey suggested 150 million Indians suffered from mental illnesses, but only 30 million were being treated properly – which means one in 20 Indians suffers from depression. Add the problems children face today and we have a ticking time bomb. The survey also pointed towards disparate distribution of mental healthcare facilities, which are largely urban-centric, and paucity at all levels of care, be it in number of personnel or centres for treatment and rehabilitation. 

The only assistance that India has a surplus of is the pill. We may well be on the path to becoming Prozac Nation 2

We are turning into a nation of high psychiatric morbidity and bad psychological health. If our population has mental baggage that it carries in daily affairs, the future may be bleak. But can an epidemic of psychiatric illnesses be similar to other illnesses such as diabetes? Are psychiatric illnesses a disease or a distress? Our society needs to examine their causative factors; the writing on the wall is clear: high levels of stress and a changed focus of people in a liberalized, global India. The rush for material success, where profit drives people rather than the pleasures of life, is an oft-repeated discourse.


The pill remains a major weapon for doctors, while non-drug routes struggle to prove their efficacy. 

A reactive mental health industry has much to contribute. Overpowered by the global pharmaceutical industry, psychotropic medication is over-prescribed. In the absence of guidelines and a shortage of psychiatrists, most clinics have 30 to 50 percent patients with psychiatric illnesses, and anyone can freely prescribe psychiatric medication. The lack of training sends rational psychopharmacology for a toss. 

Part of this problem is organic to psychiatry. Unlike other medical disciplines, it does not look at causes (until very recently). Diagnoses are largely made on the phenomenology and syndromal descriptions. The drug treatment is very effective in ameliorating symptoms, thus creating an algorithmic exercise of mix and match. We have to wait for this fundamental change till neuroscience alters its approach. The pill remains a major weapon for doctors, while non-drug routes struggle to prove their efficacy. 

But the real danger has socio-economic roots, and deeper ramifications. Human behaviour is culturally rooted and so are its problems. The prevalence of diseases may be universal but the medicalisation of life is a relatively new phenomenon. Anxiety is part of life, but to solve it with medical intervention is a short-cut. Affluence can lead to certain issues, while poverty may create a different set of issues. Hence the need to look beyond just the diagnosis and the drug. 


 


We will have to question very soon whether we need to explore inherent mechanisms to stabilise our psyche or be ready to follow a Western model of life and disease.

 

The helplessness and stress of living in modern times, especially in crowded and resource-crunched countries, create symptoms mimicking illnesses. When religion and social buffers fail, hospitals step in. Impatience pushes doctors to label the ‘problems of living’ and ‘social suffering’ as illnesses. What in older times would have been handled with strength from inner, family or religious resources is now regarded as depression and anxiety. Such labelling of life’s conflicts takes away people’s coping abilities, and their minds take shelter under the umbrella of treatment. The myth of lifelong psychiatric medication emanates from a reluctance to let go of medicine’s crutches. The pertinent question should be, are we talking about mental health or mental illness? Or are we fallaciously confusing the lack of illness as health?

Mental health by WHO’s old definition is “a state of well-being in which the individual realises his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community.” The underlying theme is the unstated harmony between often contradictory thoughts and situations, a focus that was highlighted in Eastern philosophy. The route to health was correct living (without being moralistic) – the attempt to prevent before the cure. Formative bricks had to be laid out in growing years through critical thinking in education and training. We have to understand the conditioning of the Indian mind within its own cultural and social context to help people differentiate between life issues and illnesses. Not just mental health professionals but intellectuals and scientists are responsible for breaking this down to the population. 

We will have to question very soon whether we need to explore inherent mechanisms to stabilise our psyche or be ready to follow a Western model of life and disease. If we really wish to take pride in Indian and other Eastern traditions, we have to move beyond the rhetoric and delve deep to rediscover the psychotherapeutic elements within our culture, and integrate them with our modern scientific understanding of the mind and the brain. Only then will we be talking about mental health. 

This story is from the print issue of Hardnews: OCTOBER 2017