What is mental illness?

people are like stained-glass windows. They sparkle and shine when the sun is out, but when the darkness sets in, their true beauty is revealed only if there is a light from within.

Elizabeth Kubler Ross


Can mental illness be treated?

Questions frequently pondered upon by patients and family members include-

Can the illness be treated?

Will the doctor prescribe psychiatric drug?

Will I be addicted to these drugs?

Will the medication cause side effects?

Will the medication be needed for lifetime?

Can I get treatment without medication such as talking treatment?

Can I recover with alternative treatment such as Ayurveda, homeopathy, faith healing, religious practices etc?

Can the illness be treated?

The answer to this question is a definitive ‘yes’. However, one need to understand that mental illness is very different from general health condition and requires the expertise of mental health specialist i.e psychiatrist. A through assessment, diagnosis and formulation is essential for accurate treatment.

Whether it can be cured permanently depends on the nature of illness and lot of other factors.

A significant majority recover from mental illnesses.

Will the doctor prescribe psychiatric drugs?

It depends on the assessment done and expertise of the doctor.

There have been significant advancements in drug treatment for mental illnesses. However, they take care of biological component of illness only.

It is better to ask your doctor all the questions you have about these medications. Another good idea is to ask your specialist about alternative treatment options.

Most of the psychiatric drugs are safe to use but requires regular follow up with specialist.

Will I be addicted to these drugs?

Most of the psychiatric drugs are non-addicting.

The most commonly used addicting drugs are of benzodiazepam group such as drugs like Diazepam, Lorazepam,Alprazolam, Clonazepam. Their use requires regular monitoring.

Sometimes sudden cessation of drugs leads to discontinuation symptoms which may be similar to psychiatric symptoms. This gets better with restarting of medications. His could make people believe that these medications are addictive.

It is always advisable to consult your psychiatrist or physician before discontinuing psychiatric medications.

Will the medication cause side-effects?

Psychiatric medications could cause significant side-effects if prescribed in higher dosage.

These medications are second most common side-effect producing medications after anti-cancer medications.

Fear of side-effects could lead some physician to prescribe lower dose of medication at the cost of effectiveness.

Some patients reduce their dose without consulting the specialist with subsequent relapse of psychiatric illness.

Most of the side-effect is reversible provided it gets identified and treated.

Some of the side-effect could occur with the use of more than one medication together. This might be the case for treatment resistant conditions. That is why a good idea is to consult a psychiatristin such cases.

Will the medication be needed for lifetime?

This is not the case in majority of suffers. A significant minority will require lifelong treatment.

Your psychiatrist experienceis one of the most important factors in deciding the duration of treatment.

Can I get treatment without medication such as talking treatment (psychotherapy)?

This can definitely be the case in a significant number of patients.

In some cases, both medication and talking treatment will be needed.

Anxiety disorders and personality disorders respond better topsychotherapy.

Can I recover with alternative treatments such as Ayurveda, homeopathy, faith healing, religious practices etc?

It is very difficult to say about the effectiveness of alternative treatments due to lack of good research evidence.

Only alternative treatment with some effectiveness in some conditions as per research done is Yoga.

In some cases alternative treatment could be potentially harmful as they promise to cure the mental illness and this leads to cessation of medication with subsequent relapse.

What is ‘holistic approach’ to treatment?

Holistic approach incorporates all the dimension of psychological problems in treatment.

These include treating biological, psychological, social, cultural and spiritual aspects of illness.

This approach focuses not only on mental illness but also on mental wellbeing.

It aims to do psychological healing rather than psychiatric treatment only.

What are the challenges of treating mental illness with drug treatment only?

Although psychotropic drugs exert profound and beneficial effects on thinking, mood and behaviour, they often do not change the underlying disease process.

treating doctor needs to be realistic about how much improvement can be achieved through drugs as excessive dosing can cause some significant side-effects.

In a significant minority of cases, medication needs to be continued for a long period of time even after improvement of symptoms to further the improvement and prevent relapse.

Some people are so desperate to get better that they often request for change of medication or they change their doctor. This can result in a very complex medication regimen.

Some of the suffer do not believe themselves to be ill and don’t agree to take the medicine. In such cases, compliance therapy could be a helpful management option.

Are neurophysiciansthe expert in treating mental illness?

Most of the neurophysicians in India are MD (general medicine) or DM (neurology). As such they can prescribe any medication. Only psychiatrist is having special training in prescribing these medications.

Contrary to popular perception, they are not given any specialised training in prescription of psychiatric medications.

Most of the people prefer to visit their physicians or neurophysician with psychiatric problems due to believing their problem as originating from ‘nerve’ or ‘brain’.  This helps them to avoid the stigma of being labelled as mentally ill. But idea should be to recover from mental illness with appropriate treatment rather than avoiding the labelling of problem itself.

It is a good idea to consult your psychiatrist if symptoms are not improving or side-effects are problematic or you feel your physician is not able to understand your problem.

Are psychiatrist are doctors having a MBBS degree?

A degree in psychiatry is obtained after completion of MBBS.

This degree is awarded in the form of MD (Psychiatry) or Diploma in Psychiatry or Diploma in Psychological Medicine (DPM). While MD is a degree awarded after 3 years of specialised training, DPM is awarded after 2 years of specialized training in psychiatry and neuropsychiatry.

What is the difference between clinical psychologist and psychiatrist?

While psychiatrist is a mental health specialist having a MBBS degree with further specialization in psychiatry, clinical psychologist have no MBBS degree.

Psychiatrist can do investigation to find out causes of mental illness which psychologist can’t. Psychiatrist can prescribe medications while psychologist can’t.

Both can do psychotherapies.

Can a psychiatrist read my mind?

This is a common misconception among people. Psychiatrist make their opinion based on the history provided, behaviour observed and subsequently make a hypothesis about the problem. This is based on various scientific psychological theories with proven research evidence.

Once a hypothesis is formed, it should be discussed with patients and/or family members to confirm or refute it. If the hypothesis is not correct, it needs to reformulate.