What is psychiatric illness? Psychiatric illness is caused by problems in the mind. A person with psychiatric illness may describe strange experiences (sights or sounds) which others around him do not see or hear. The person does not always understand what is happening to him. Often the person does not even know that he/she is behaving differently. In all types of psychiatric illness, the person’s ability to carry out daily activities, work, interaction with friends and family change. Some changes may be minor, while others more acute. People with psychiatric illness may begin to think, talk or act differently suddenly or within a few days, or it may occur slowly. Without help, these syndromes usually stay the same or gets worse. A person with psychiatric illness may behave strange at certain times and seem normal at other times. But usually over a few months, the person acts more strange and hardly ever acts like he did before.
“Psychiatrically ill”, not a “strange person: Every community has a few people who are odd or different. However, psychiatric illness means a big change from the way the person used to behave in the past. When psychiatric illness occurs, the way the person acts begins to pose a problem for his family/neighbours.
Causes of psychiatric illness:
(1) Stress: Everyone has duties and responsibilities to carry out. Sometimes a person begins to worry about these duties more frequently, taking up a large chunk of his time leading to stress.
(2) Chemical imbalance: The brain has special substances called brain chemicals. Too much or too little of them can cause psychiatric illness.
(3) Drugs: Many “illegal” drugs may have ingredients which can cause psychiatric illness.
(4) Injury: Damage to a person’s brain can result in strange behaviour.
(5) Ageing: As people get older, they often become forgetful, slow, etc. This is normal. But some people as they grow old, unusual changes start to occur in their brain. Some may have short-term memory loss, some get stressed out while some suffer from depression.
How people with psychiatric illness different from others: Not all psychiatrically ill people act the same way. Family members are usually the first to notice the change in him/her.
(a) Some may act worried. Sometimes he/s cannot sleep, cannot stop worrying about issues be as trivial as it may be.
(b) Some may suddenly feel his heart is beating faster, his breathing becomes faster or he might get scared. These symptoms may last for a short span of time but may return anytime.
(c) Some may look different or feel different. Sometimes they do not comb their hair or change their clothes for days. Their facial expressions can also change. They may also lose significant amount of weight in a short period.
(d) Some may always complain about their health. Even after visiting a doctor, they may complain about aches and pains, headaches, etc.
(e) Some may appear excessively happy, rather energetic or too busy for everything.
(f) Some lose interest in everything – family, jobs, education. They would rather want to be left alone.
(g) Some may begin to say strange things and take strange decisions.
(8) Some may become suspicious of everyone or everything.
(h) Some may start telling lies and believing it too.
(i) If the illness gets serious, some may see or hear things that don’t exist.
Does psychiatric illness get worse? There are so many kinds of psychiatric illness that this is a difficult question to answer. Each psychiatric illness has a different way of developing. (1) Some people may become ill only once without any symptom recurring. (2) Some illness remains static without getting worse for a long period. (3) For some, symptoms will go away only to recur. (4) Some peoples’ condition gets worse with time.
Can psychiatric illness be cured? There is still a lot not understood or not known about psychiatric illness. But with the right kind of help, a person’s illness may very well be cured or brought under control. However, some are extremely difficult to treat if not impossible to cure.
How is psychiatric illness different from mental handicap? A person with psychiatric illness may have normal or superior intelligence. Mental handicap on the other hand is caused by damage to the brain before or during birth. A mentally handicapped person is usually of low intelligence and has difficulty learning. (2). People with psychiatric illness can often be treated with medicine. However, medicine will not help a person with mental handicap to think or learn better/faster.
Warning signs of serious psychiatric illness:
*Reluctant to take bath or change clothes;
*Acting hyperactive with little or no sleep;
* Spending hours remaining in the same position;
*Talking to himself;
*Talking without making any sense;
*Refusing to interact with anyone;
*Eating or drinking too little and losing a lot of weight;
*Crying for a long time without any apparent reason.
If any of the signs occur, it is time to get help.
Ways to help: There are a number of ways to help a person with psychiatric illness.
1. Medical treatment: Medicine is one of the ways to change strange behaviour quickly. Sometimes people need a short stay in hospital. Another less common treatment is electro-convulsive therapy, usually known as “shock therapy”.
2. Talk therapy: Talk therapy or counselling helps a person with mental illness to talk about his problems making him feel that someone else understands and cares for him.
3. Routine activities: Keeping the person involved with the family routines can help the person return to his/her normal behaviour. This means asking the person with psychiatric illness to carry out simple repetitive activities which he/she used to do before illness.
4. Working with family and community: Often families and close friends are the people who can best help a person with psychiatric illness. One of the ways to help is to use routine daily activities in a familiar place.
Medical treatment: Medicine does not “cure” psychiatric illness like antibiotic drugs can cure an infection, but it changes thoughts and behaviour and can make psychiatrically ill people feel well again. Different medicines are given for different symptoms. Some medicines help make the person with psychiatric illness think normally while other medicines can change behaviour or calm him down.
Talk therapy: Talk therapy can help people with a psychiatric illness to understand why they are ill and why they need help. It is also a way to encourage and support them while they are ill. Special forms of talk therapy are called psychotherapy and counselling.
Routine activities: Daily activities at home can be used to help the person with psychiatric illness get well.
Personal care: The person with psychiatric illness should be gently reminded to bathe, comb hair and to change clothes. There are routine activities that everyone does, but people with psychiatric illness lose interest in carrying out those. The person should be encouraged and helped to carry out these activities even if he does not need to go out.
Household activities: With encouragement a person with severe psychiatric illness can begin to assist in simple things like making tea, or sweeping the floor. Sometimes you need to “make up” jobs. It should be simple and should last at least 20-30 minutes. The person should be encouraged to do as much as possible for himself even if it takes longer or is not done well. Time spent each day doing activity by a person with psychiatric illness should be increased. It is much better for him to remain busy than doing nothing.
Using familiar places: For people who have had psychiatric illness for a long time or who are very ill, the goal is to make their behaviour manageable for the family and neighbours. This will help the person with psychiatric illness remain out of hospital and live in the community. Staying in the community can be better for the person with psychiatric illness because the family is there to help; the person can keep carry out his routine activities; the familiar environment can also be helpful.
What can the family members do: The family can identify the types of activity or events which make the psychiatric illness worse. They can make a specific plan about how to deal with these activities or events. These activities can be made simple and easy for the person with psychiatric illness to carry out. The person with serious psychiatric illness should not be punished in any way.
Quick reference for helping a very upset person: The information below gives some ways to help a person who is very upset or has very difficult behaviour. The first thing to do is to find a doctor. Till a doctor can be found:
For those who are “unfriendly and suspicious of others, thinks others want to harm him, overly watchful of things going on around, has ideas which are not real”.
1. Do not argue with the person about their ideas or thoughts or try to prove them wrong.
2. Change to a concrete topic that is not related to strange thinking.
3. Be friendly and accepting. Do not get angry with the person.
4. Do not whisper or talk secretly when the person is in the same room or near by.
5. Do not talk or do things behind the person’s back.
For those who are “restless, constantly walking back and forth but going nowhere or very excited, moving around quickly without a reason”.
1. Do not try to hold on to the person.
2. Call him and get his attention.
3. Firmly but without anger, ask him to come to you.
4. Tell him his behaviour is upsetting you and you would like him to stop.
5. Try to get him to help you with simple activity.
For those who “avoids people and won’t let others come near”.
1. Approach the person slowly and in a friendly manner. Stop in front of him but at a distance and greet him in the usual way.
2. Talk to him first about things you both can see e.g. “Is that chair comfortable”?
3. If he answers, continue with simple talk telling him that his family is worried. 4. If the person stops talking, try again to get him to answer. If he becomes restless, thank him and leave.
5. Have the family members continue with their daily activities near the person so that they can see one another.
6. Family members should continue to talk to the person even if he does not answer and make sure the person receives food and drink.
For those who are “aggressive, have bullying behaviour, suddenly strikes out or hits other people.”
1. Stay calm and do not show that you are frightened but quickly call or go for help.
2. Speak in a firm loud voice: “I would like you to stop”.
3. Remember that the person does not always know what he is saying or doing. 4. Give the person an activity which requires him to use his energy, like loading a large bag.
5. Do not let him use tools that are sharp or that can be used to club.
6. Instruct other persons not to argue with the person and to stay away till he calms down.
7. When the person is calm, talk to him about his behaviour. Make suggestions about more activities he can do which can keep him calm.
For those “who are suicidal”.
1. Someone should be with the person all the time.
2. Talk therapy can be used to remind her of all the useful things she has done and that she is not a bad person.
3. Try to get the person to do some routine activities, but do not leave her alone.
4. Only when she begins to say good things about herself is it safe for her to be left alone for short periods. Even then it is best that she always be in the other people’s sight.
5. Sometimes a person will tell you about his plans to kill himself. This might help to remove any dangerous tools, poisons, etc that he can get hold of.
Dr. Satparkash has been a consultant at a psychiatric hospital in Dhaka for eight years