Data Speaks Loudly

Mental illness contributes to 7% of the global average disease burden. The number of suicides in India is double than the global average of 11 persons per 100,000 population annually. Mental maladies affect about 15% of Indian (and world) population as per latest estimates. One in six people are victims of mental illness. Depression and anxiety disorders alone affect around 8% of us.

Among the young, suicide is the third biggest killer, with depression the leading cause of early-age disability globally. In fact, mental disorders are thought to affect younger people than statistics suggest.

It’s Complicated

People experiencing mental disorders resort to one of several coping strategies: discussing the problem with friends or family, social isolation to escape being noticed, or camouflage true emotions into acceptable actions for fear of being judged or abandoned. Unfortunately, the latter two are more popular, driving forces being social stigma and taboo. There is little or no support to sufferers and their families. Surveys reveal that society even feels fearful of the sufferers!

Undoubtedly, behaviors that indicate mental disturbances can sometimes be hard to pinpoint, passed as the simple quirkiness of character than a disorder of the mind. But is the matter really that straightforward?

Lurking Around Dark Corners

As a society, we are usually shocked at the news of successful, high-performing, wealthy young individuals killing themselves. Celebrities like yesteryears’ actor Guru Dutt and Miss India 1997 turned VJ Nafisa Joseph took their own lives over strained personal relationships. On the other hand, when farmers drowning in debt kill themselves, the reasons are evident and understandable. Similarly, while some mental illnesses are conspicuous, others are not.

People closest to us know us the best; be it our habits, mood swings or fetishes. Yet, in this fast-paced life in the 21st century, signs of distress escape the friendly radars of our loved ones and our own selves. Besides the lack of free time, our reluctance to understand these complex phenomena, ignorance and social stigma worsen the situation for sufferers. Depressive bouts are confused with laziness, anxiety simply called lack of focus and attention deficit equated to incompetence. Such labels make a negative impact, especially on the young impressionable minds. In fact, half of all mental illnesses begin even before the age of fourteen!

Is It All In Our Heads?

Brains are complex machines. Scientists have been studying it for years to find neuropsychological causes and genetic bases of mental illnesses, which are many- depression, anxiety disorders, eating disorders, cognitive disability and so on. To understand where the problems lie, researchers dive deep into the workings of the brain. The clockwork includes a huge repertoire of chemical and electrical signals that pass between connected brain cells called neurons. Imbalances in signals between or within different parts of the brain result in myriad mental anomalies.

Anxiety is a result of an over-active amygdala- the fear center of the brain, resulting from an imbalance between excitatory and inhibitory signals for this area, making sufferers more nervous and fearful than normal people. Severe anxiety disorders such as panic and post-traumatic stress disorder (PTSD) involve the same parts of the brain, only different disturbances in the ongoing signaling.

Depression, on the other hand, appears to be more complex. Firstly, the levels of chemical signals (neurotransmitters) called serotonin and dopamine are abnormal. Serotonin signals well-being and happiness to our brains while dopamine induces motivation. Secondly, the brain tissue is sometimes shrunken. Third, the ability to form new neurons and connections or repair and modify old ones is impaired. Lastly, immunity modulators called cytokines, which induce sickness behavior like staying indoors, sleeping a lot and generally, low energy levels are found in excessively high amounts in depressed individuals. Cytokine signaling is in fact elevated under chronic stress. Though depression manifests as slow behavioral changes that evade our observation, often simply under the cloak of sadness, it is a serious medical issue.

These findings imply that maladies of the mind are just like those of the body, say cancer or diabetes- complex diseases that manifest upon an interplay of genetic predispositions and environmental triggers- preventable, manageable, treatable. Basically, balanced neurological circuitry is essential for mental health.

Interestingly, we have also witnessed that most people tide over adversities, but some are unable to- not every victim of bullies becomes mentally ill. What determines mental resilience? Environment? Education? Or simply will power? Studies suggest that a feeling of security, purpose in life and positive experiences are the foundations to mental resilience. The sooner one starts building it, the better, but there is never a wrong time to build resilience. These building blocks are present both within and around us.

Happiness is Health

Preventing chronic negative thoughts is the key to a healthy mind. Children especially need to be allowed more leisure time. Physical activities like exercise, sports and dancing are known to release feel-good hormone endorphin which benefits the brain. Pursuing hobbies, activities that make you happy or fulfilled and content can keep you motivated in low phases of life, teaching you to celebrate little victories. A hearty laugh works the same way.

Invest time in friends and family. Talking to and confiding in someone trustworthy helps you create a support system that you can summon in times of distress or crises. Give the children around you their due time and attention. Cuddling with a pet and playing with kids generates oxytocin- the bonding hormone. Above all, sleep well, for it helps your body and mind heal itself. Rejuvenate them both time to time using tools like meditation to keep serotonin and dopamine balanced.

If circumstances still catch you unaware, know that help is out there, if not in your home, at the touch of a button. Mental health foundations and support groups are at your disposal if only you call them for help. Phone helplines and online counseling portals like “Type a Thought” and “mystruggles.in” – that keep your identity anonymous, exist to resolve your distress. Sometimes simply talking to friends or family is enough to help you tide through. If none of the above helps, tap into professional psychiatrists. Taking medication to relieve yourself of sickness is not a shame. Do you think twice before taking a pill for cold? You might not even need medication. Interventions like Cognitive Behavioural Therapy (CBT) and Neuro-Linguistic Programming (NLP) can help you learn new thinking patterns, overcoming anxiety and fear.

If only we as a community realize that mental illnesses are not chosen by those who are ill, like any other ailment, and fulfill our roles as parents, teachers, and caregivers, healthy and happy youth is not a distant dream. If only we would give children enough time, attention and affection, they would not grow up as broken individuals. If only we learn to ask “How are you?” and really mean it; if only someone were to ask us “Are you alright?” at our most terrible times; if only we accepted the differences among people; if only no one shamed the fat teenager; if only we didn’t burden our children with our ambitions and expectations (and maybe instead followed them ourselves), we could save lakhs of lives. And that would be a life worth living. Wouldn’t it?

We must remember, childhood and adolescence are tender, confusing and ruthless, all at the same time. Young minds need a sense of belonging, affection, and appreciation to grow up normally with nurture, cautious prodding and guidance at every step. This journey translates into meaning and purpose around which their entire adult life would revolve. Many mental illness victims report feeling unloved, unnoticed, or worse – blamed, bullied, beaten and shamed as a youth. So, if we want to save more people from mental disorders, the younger we catch them, the better.

About the Author

Nishtha Bhargava is a Senior Research Fellow at CSIR-IGIB. When not in the lab, she likes to listen and dance to her favorite music, read books and dream about the future. She believes animals, children, and drunk people never lie and that science has the power to change the world.

Healthy Eating

The whole process of ‘eating right’ starts with buying the ‘correct’ food. Planning and then preparing a meal using suitable ingredients is just as important. Healthy eating is essential. Cutting down on your favorite sweets may be a real challenge. However, in today’s day and age, there are several substitutes available in the market. Monitoring carbohydrate intake, avoiding sweets, sweetened drinks and trans-fats is essential to keeping diabetes under control.

Being Active

Staying active through physical exercise and continuing to do as many tasks by yourself will not only ensure that your body remains toned up but, will also ensure optimal utilization of the sugar you may have eaten and release of ‘happy hormones’ such as dopamine, serotonin, oxytocin, estrogen, and progesterone. Setting realistic and do-able goals will give a sense of achievement, for example ‘today I will tidy up my cupboard’ (dopamine); reducing stress by spending quality time with loved ones and pursuing a hobby, a physical exercise routine (yoga, going for a walk, dancing, etc.) and meditation are some ways to improve the levels of ‘happy hormones’ in the body.

Monitoring and Taking Medication

This can be easily achieved by encouraging the person with diabetes to have a schedule. Keeping fixed times for meals and medication decreases the chances of ‘forgetting’. Reminders in the form of alarms (phone and clock) are both useful. Keeping your medicines at a place where you can see them is crucial to compliance. Making a checklist and ticking each item off as you complete the task on a daily basis can also help elderly persons who may have memory issues. Family members to have a major role to play in monitoring and taking medication. ‘Cheating’ on food issues reduces drastically if someone else is monitoring and if the foods to be avoided are kept either out of reach of the person (for example, under lock and key) or not kept in the house at all.

Coping in a Healthy Manner

Persons with diabetes have to face the challenge of living their lives with the knowledge that their condition is incurable. This can have a major psychological impact on the person. With information on the disease available freely, a person may be overwhelmed by the complications that might occur. Family members need to be supportive in order to ensure that the person with diabetes follows the treatment prescribed and stays positive about his or her future. Increasing awareness to the family members is crucial for prevention of complications. Participating in activities that are purposeful, nurturing a hobby, spending time with loved ones, doing the mundane but important things of life such as ironing, dusting helps maintain a routine and is crucial for a good quality of life.

Also Read:
Advantages & Disadvantages: Real-Time Health Monitoring Devices
Needle-Free Diabetes Care

Problem Solving

A person with diabetes sometimes might even feel helpless. Helping him or her to become a problem solver is an important component to ensure independence for a longer duration of time. This means that instead of always looking around for someone else to do your job or find a solution for a challenge simply ‘DO IT YOURSELF’. For example, if you are unable to go grocery shopping by yourself, think about home delivery options. So, all you need to do is pick up the phone and call your local grocery seller or order online!

Reducing Risks

Wound healing takes longer in a person with diabetes. Hence, it is important to reduce the risk of injuries at all times. An occupational therapist can carry out a ‘floor slipperiness’ assessment, incident, and injury survey, and hazard surveillance to reduce the risk of an injury or a fall. For example, a person with diabetic neuropathy – a complication which causes the nerves to be affected resulting in less feeling in terms of pain, temperature (hot or cold) or pressure (tight or loose). Such a person is at a major risk of getting injured. Burns during cooking are common as the person is unable to feel a ‘hot’ utensil. A simple modification like microwave cooking/heating or using protective gloves can prevent any foreseeable injury. Removing potential hazards such as loose wires and carpets in addition to wearing slip-resistant footwear and placing non-skid mats at strategic places can prevent falls.

Occupational therapists also prescribe, train and educate persons with diabetes in a suitable household as well as environmental adaptations. For example, a person with diabetic retinopathy – a complication when the blood vessels of the retina in the eye get damaged leading to loss of vision – is prescribed, trained and educated in the use of visual aids such as magnifying glasses and using closed circuit TV. The importance of reducing glare, using contrast images, bright colors and appropriate lighting to improve the seeing ability is emphasized. These methods are also incorporated at doors, stairs, and other potential fall areas. Organizing things around the house so the patient can easily find things helps not only patients with vision impairments but also patients with memory issues.

It is essential that any person with a chronic condition such as diabetes continues to lead a normal life. This helps retain meaning and purpose to their lives. Helping the person with diabetes plan and maintain a routine which has time slots for all essential elements in the care of diabetes such as mealtime, when to take the medication, exercise, work and leisure activities, is one of the most important areas of Occupational Therapy. Helping the person understand that there are various ways that one can maintain one’s independence without compromising on the quality of life or safety is the key to living with diabetes. All that is required is a little discipline and lots of care.

About the Author

Dr. Monika Kundu Srivastava is an experienced Occupational Therapist with specialization in Neurologic conditions. She is currently working in a hospital set-up. Besides being a clinician, Monika is also an experienced writer and editor.