Mod-03 Lec-14 Mental health and illness I

Mod-03 Lec-14 Mental health and illness I


There is a whole new zingo or lingo, whatever
vocabulary, whatever words you want to use, has come up in the last 20 years in the
world and one of them, the most popular is stress. You have heard of this word, all of you, and
around this stress there is lot of other words, which has come up, things, which were
not known to people, like depression, like mental disorders. And on the periphery has emerged a whole billion
dollar industry to keep people mentally healthy, these are pharmaceuticals,
these are self-help books, selfhelp gurus and what not. It is a huge industry. How is this supported? This is supported by some data. World Health Organization says,
by 2020 every 4th Indian will be taking anti-depressant or anti-anxiety drug. This is what
they said about 10 years back. Last year they said, that 36 percent of Indians
are depressed. And believe me, anti-depressants and anti-anxiety
drugs are the most prescribed drugs. Some people say depression is the number two
killer in the world. What is all this mess? You really do not know what is the truth,
so it is worthwhile to examine, that what is mental health because
obviously, what do we all strive for? We
strive for being healthy and being mentally healthy. But if 36 percent people in the
country are not well, it is a very, very sinister sign. So, I think it is not only a prerogative
of psychiatrist and mental health professional and psychologists and the policy maker
and the pharmaceutical people to know what is the truth, it is a prerogative of everybody
to know it. This is the truth and fact and statistics. If you believe statistics is truth, then this
is the truth. But on the other hand, there is a whole lot
of confusion in it, even the basic definitions. So, what we are going to do in next half an
hour, 40 minutes, we just trace it back and let us see what happens, what is
mental health and what is mental illness and how do mental health professionals perceive
it, how does the society perceive it. Because
obviously, nothing works in isolation, none of them is an island. So, it has to be an
interactive thing. .So, let us go back, let us go back to the
farthest point in history, the first sign where we
know, what we call, you know, the common word, which is used in India for mental
illness. What is it? .FL]
. translation is mad. So, I am not talking mental illness; that
we will see what it is. Mental illness is a word, which came in the
last 50 years, courtesy us and courtesy people activists and all that. But what would being used in literature and
history was word called madness. Let us go back to the first sign of madness. . Do you know the man here? Two men, who are they? .ord Krishna. Lord Krishna and? .rjun. Arjun. Imagine, that this is not mythology, this
was a story. There was a war. There was
a man called Arjun who was the best warrior of that time. The whole war hinged on that
man’s performance, right. And he goes there and he says, I will not
fight. What was he
undergoing and what did Krishna do then? What did he do? ..ounsel; counsel. Yeah, that was the, even if you go further
you will find more stories, but let us take this
as starting point because there is some people say it is mythology and even if it was true,
it was happening at the beginning of those 5000 of years of history we know. We do not
know the history of two lac years; we know history of 5000 years. So, this man suddenly went into what? What happened to him? It has happened to all of
us at some point of the time, exams, entrance, competition. .epression
Depression is a, one acute depression is just and if you read this text call Gita, read
the first chapter, you will know what was happening. Arjun was saying my hands are going
loose, they are shivering and I am sweating and I have, my mind is going blank, I am
getting dizzy. All the signs of an acute panic attack. You listened to somebody who is
having a panic attack or acute depression, somebody wants to run away, will tell you
the same story. So, that was a first described acute attack
of depression and the first psychotherapy in action. Krishna was not, Krishna did not take him
and said come to my chamber, let us sit across the table and couch and talk. He said, boss let us do psychotherapy here
itself and he did the wonderful psychotherapy. That psychotherapy still remain the best. But if there was a
madness that was madness, there was a method in it. That madness was not very deviant,
it was in a war field. So, you are asked, being asked to fight, you
do not fight, you get into certain physical symptoms, your mind
just gives away. And there is a man, luckily
who is sitting in front of your chariot, who turns back and says, not everybody is so
lucky. Not all Arjun’s have Krishna’s, at there,
by there side. So, that means, it was well known, even then
people did not call it madness. But if all
these symptoms are put into a modern classificatory system, Arjun will get a label like
we are used to giving labels to everything. Read this. Let us come to Greece. Socrates is one of the oldest philosopher. I am just
telling you what, what is, has been the view point over time towards, what we call,
madness, today. So, acute depression was not called a madness. Krishna told him to .fight, that this is fine, temporary thing
to go off. Panic attacks still remain the same by
the way. . Socrates has said, that madness is nothing
to be ashamed off. All great things come out
of madness, right. Madness comes from God. So, where sober sense is merely human
and you all have heard the word called, there is a very thin line between a genius and a
mad man. Some people remain on the both sides of it,
one has to choose which side. . .And this is, people prefer madness if at
tall they did anything call madness. So, there was
a whole lot of people who took pride in the madness: Socrates, Abraham, Shakespeare
has written everywhere, you see Hamlet, you see Macbeth, everybody. So, the big minds
of all times, the literature, the philosophers, they, they never thought . madness is
something, which should be thrown out. They actually loved that by nature, which
are brand psychotic. In our times Saadat Hassan Manto, the greatest
Urdu short story teller, actually had psychotic break down. Vincent van Gog, John Nash…
.ohn Nash. John Nash, now what has happened over time
is that these people started getting labels. And once society started giving them labels,
then this whole concept of psychiatry and mental health and everything started. . Let us see what are the labels they received. First of all, all these people were considered,
once they started thinking about this as illness, then all labels started. We are very,
human beings are very fond of giving labels. They cannot live without labels because
labels give a certain framework, labels gives certainty. If we do not label anything, it is
all free. Then, what is a problem? The problem is uncertainty that will keep
creating anxiety. .Everybody wants to have a certain mindset
to know the future. Now, what will next step
is going to be. If you are just send out in the open and said
there is no label, you would not do what you want. It will be a very, very discomforting and
disturbing experience for most people unless you have really trained
your mind to be like that, into free flowing area, but that is very difficult. These are some of labels you all have heard. This, insane, we still use this word, right. We do not use this word in psychiatry anymore. Insane is against what? .anity. Sanity; is sanity defined? I am just throwing some questions, keep thinking. .o
When sanity is not defined, you are calling somebody insane, does not matter. Lunatic, you have heard this word called lunatic,
lunatic asylums. We do not use this
word. Lunatic asylum came from what? Lunatics came from what? It is a raving lunatic,
people used to say about Hitler, . lunatic. Lunatic came from what? It was observation by some great people, that
with the lunar cycle some people used to become disturbed on a full moon day. They almost equated to like sea, sea tides. There
will be two, three days in a month where this people will be disturbed. At that time there
were no other biological explanation. So, what they thought was, that because it
is a full moon and this, all these, they did not even
know magnetic field at that time. They just
knew, that it is a full moon and there is a disturbance, so the… This corroborative research, corroborate a
set of facts with the other facts is still the hard
core research method in psychiatry, today also. So, lot of research, which goes in
psychiatry and mental health and all that. Sometimes you will really wonder is, what
is happening. Nothing is happening, it is the same lunatic
thing going on, full moon, illness. We find it here, that five people who walk
on the, who put the first left foot forward fall. I am just throwing it, somebody may really
find it. You should walk with you right foot
forward first because you put left foot, chances are you may stumble. So, these type of
thing, corroboration, it may not be the best way, but that is the only way. Abnormal against what? ..
Big question, big question. Mad we all know. In some societies, is mad people were not
considered as mad, they were actually considered as bad. Have we evolved from that, yes
or no? I do not think we have evolved. If you just look what was happening in our
country few days back in Delhi, we are really not sure those people were mad or bad. One of them died also. How to decide? But then, there are systems evolved, there
are certain things with the intent, there is an
intent, you call them bad and there is no intent
you call them mad, right. So, poor man will lift, suppose bread, from
a shop and a rich person who lifts up a watch from a shopping mall, who is mad and who is
bad, have you ever thought? Lot of film
stars were caught, Dubai, in Dubai lifting up watches and putting in there purse, but
a person who steals a bread, who does not have
food, who, who can you decide. It is very
difficult. It is very difficult, really, I am telling
you. Just why I am stuck telling you all these,
that is very easy to tell you how we decide, this
is mentally ill and this is, one of you may come and say I am having this and if I am
a good psychiatrist I will not take time and
put a label on you. And that is not the best way
because it is very difficult to decide, very difficult to decide what is what. Because a
person who lifts shop or rich person who lifts up is called a kleptomaniac, right, that they
have a compulsive stealing. This person who lifts up is hungry. Act is the same, different
context, but the context decide. But this is the big thing, context. But do you work on context is the question. The same
panic attack for Arjun was a context, but a panic attack when you are coming out of
the lift is a different context, alright. There is no big deal in coming out of the
lift or going into the lift, but you go into the lift and
you have a panic attack. Not so, now, after all this lunatic asylum
and activism and some people thought that and
they thought it correctly, that why delegate people by telling them you are lunatic or
inferior or whatever, alright. We started calling it mentally ill. So, now there is a whole
lot of activism, which is going on, which I do not know what will come out in next 20
years, like let me give you an example. .All this children who have deficits, like
mental retardation and all this, these are all
diagnosis, but people have stopped calling them as deficient children or deficit or
abnormal. They have started calling them mentally challenged,
alright. Yeah, when you
can call them mentally challenged, I do not even call them mentally challenged. This is
what is the problem, but because, I will tell you why we call them. We will discover why
have we started calling people like this and that and… . What is normal? Can anybody define what is normal?
.he characteristics, which are shown by majority of the population. Right, so is normal, what is statistically
normal? . statistically. Alright, any other definition. .ctually, there is no definition. Yeah, last lecture I had sentence, which was
very crazy sentence, lot of people will kill me for that. If there is, normal sanity is insanity. Normal sanity is insanity because most
of the time you are trying to do what others do. So, if you are trying to do what others do,
you are insane or sane is a million dollar question. .I am not telling this here, I will tell it
to psychiatrist also, they may outcast me someday,
but never bother, think over. I mean, I will, I will throw more question
today than answers, but you, because you are going to
run this country someday, you will be making policies and all that. So, if you keep this thorn in your head, someday
you may really modify things. I agree your definition, this is what we are
taught, ok. . Let me take an example of intelligence. You all know what IQ test is. IQ test is the
mental age upon your real age into 100, agreed? This is just a number. If I say you have
IQ of 140 and I have a IQ of 70, what does it mean? What does it mean? Nothing, does it
mean anything? You have your life, I have my life, you may
make a rocket, I may make ., how does it matter? How does it matter? It does not matter. But you know, what
happened at the beginning of 20th century and even before that, 19th, this drama was
used to control people. Psychiatry has always being a big tool in
that hands of politicians, psychologist also. This tool was used because you see, this is
the bell shape curve, 1 standard deviation, 2
standard deviation, all populations comes into that, right. So, normal is in-between n less,
n less, right. This was being used by some people to control
the black population. That is
how they came to it. They said, they have less IQ, like dalits
were told they will, they have less IQ. .Who, who said there is less IQ. When you do this test, if I am not playing
attention to it or if I am anxious I will perform badly and
they are heavily, verbally loaded, which were done initially, right, heavily verbally loaded. So, if I have not been given a chance to
develop my language, I will not perform well. So, after sometime, after 50 years of all
this drama, some people started devising performance test, that is fine if you are verbally
not good, let us perform. And now, anyways, it has evolved to more or
less sensible level. So, IQ tests are normally now used for certification. I, I, in my last 10 years I have not
bothered to get an IQ test done for anybody. Even when this states mental retardation,
I say damn it, do not bother because what will
you do? The moment you get a IQ test, you
know what happens? This is the source of all drama. Source of the drama is, that if I do
IQ test and I tell, that you have IQ of 80, this information will be in your head for
life. And the moment I tell you, that your IQ is
80 and Albert Einstein’s IQ was 160, you will
start comparing unnecessarily. You get into a loop of inferiority complex,
I cannot do this, I cannot do that and this, then that
drama. And what will happen is, that you may
have a potential, but it will not work. I am just telling you an isolation about intelligence. So, now what, the theory has changed. They say, there is guy call Gardener. Gardener
said, why you are bothered about IQ and all that. There are 7 types of intelligence and
there are many more type of intelligence we do not know. Some people are motor
intelligent. Motor intelligence means, they can use their
body very well; dancers, athletes, cricketers. Some people use their music intelligence;
all great musicians and music sense is wonderful. You may have your visual intelligence much
more developed than your verbal intelligence or you may have
verbal, even interpersonal and intrapersonal. Some people have very good skill of solving
others problem. Politicians,
they have such good interpersonal skills; some people have very good intrapersonal
skills. So, there are whole lot of type of intelligence. Why do you have to have a unitary construct
of signal IQ? It means, that in somebody
one type of intelligence may be much more developed than the other type, that is what
is being understood now, which is fine. And this is all the result of all this churning,
which is going on last 40 years in our heads because
we also do not like, that why blame people, why tell them this and that. But anyways, that is how the world goes. .So, and so, if it can happen, intelligence,
it can happen in lot of other things. Your own
information taken out of contacts can be used to label. These are the confusion, which
actually prepared in the minds of people who have made classificatory system and I will
just bring you to 2013, what is happening. We are, we are amidst a huge crisis right
now, the whole psychiatry, ok. . So, what is mental health? This is a definition by WHO, is not just the
absence of mental disorder, it is defined as a state of well
being in which every individual realizes his or her
own potential, can cope with the normal stresses of life, can work productively and
fruitfully and is able to make a contribution to her or his community, alright. What it does not talk about? It does not talk about what, when and how. We all have, if
you apply this definition onto yourself, there would have been occasions when we would
have not been mentally healthy because there are times when we are not realizing our
potential. There are times when we are not able to cope
with normal stress. We all go
crazy, if at all there is something called crazy, but does that, yeah…
.his definition looks . taking human beings as robots,
more like a machine. Absolutely; WHO is being paid dollars for
all this. They, see the problem is, that people,
that is what I am saying I have. Why I am challenging this whole concept? I am not .challenging in this lecture, but most of
others challenging this concept because these are
definitions, which have been made putting into the, into a larger frame of life. What about dimensions life is in, and there
they did not realize the whole problem because we are, we have not evolved a perfect
system of it. There are reasons for it and
as we go along you will know why this definition has been evolved. . Now, this is mental disorders. If that is mental health, this is mental disorder. It
comprises a broad range of problems with different symptoms. However, they are
generally characterized by some combination of abnormal thoughts, emotions behavior
and relationship with others. By these two definitions all of us, some,
at part of time would fall into being mentally ill,
but it is not so because when once we started defining mental illness, you also put tag
of duration onto it. Like, if you are sad for half a day, we would
not call it depression actually. You have to be persistently sad for two weeks
or similarly, if you have a single panic attack you do not treat it. You have four panic attacks in a month, then
you treat it or if you have such symptoms for 1 month,
then you are called this, so that once in a
while you have all this, it will not qualify for mental illness. How we reach this duration and all is again
we will see when we talk of DSM. So, what
is in, when we, when we do not know what is normal, we do not know what is abnormal, .right. So, how do we decide? Are this people who are mentally ill different
from us? Are
they people were born from some other species, are they different, another descendants
from Mars? No, they are like us. If you remove their mental illness are not
they like us? They are, that means, we are no different. . Big question. So, that two things, which we still do not
know, whether mental illness is on a continuum from healthy, normal to, there
is a little problem. You have adjustment
reaction ditched by your girlfriend/boyfriend. You go into a tizzy for two weeks. It is an
adjustment reaction, you bounce back 100 percent. The people who face such situation,
will go into depression. So, it is a normal reaction. So, somewhere between that and then
to a minor illness. And then to, is it this from mental health
to illness, that all of us have a potential of what a fully mentally ill person
has. We may be at 10, he may be at 100 or it
is a discrete, are they different people? Are they people who were not like us? But if they are not like us, they are in our
families. Even if they are not like us, they are,
in our families, are those families different where there is mental illness or are they
in our families. I guess they are in our families, then they
are no stigmatized separate families, that this family will have mental
illness and this family not because there is
such a wide spread gene tool, which is in all of us. 90 percent genes are the same from
our African grand, grand, grand, grand grand mother that is a same gene. So, whether .gene pool is the same, then the tendency
to have illness is the same.This is something which is very concrete. So, who is ill? Statistics
. Who is this man? Was he ill? Was he ill? When whole England was in overcoat, this guy
was moving with a shawl and chappal, not even a sock. You know this famous story, he
went to meet King George, right, in his, this is slightly under dressed. When he is
slightly overdressed he has a shawl and he walks up and he said Mr. Gandhi somebody
says, Mr. Gandhi, do not you think you are under dressed to meet the king. He says, does
not matter. He is over dressed for me. Was he ill? Big question, the outside the strategy
this is out of even that two standard deviation, the last tip of something, there is a line
there. Now, this is very important to think, think
over sometime in your life. Can mental health be defined by a unitary
construct? Let me give you an example. I gave
you one example of stealing. The other example is, if suddenly one of us
removes our clothes and start wandering on the street
with just one leaf to cover your below waist, what will happen? In this campus, I will tell you the destination. The destination is health
center, counselling office, health center, me or Sandhya Mahendru or mental hospital,
right. You go to a place called Bastar in MP. They still live like that. Forget Bastar, 10
years back I used to drive from Agra to Jaipur, near Bharatpur where there is a bird
sanctuary, women in the whole two three villages, they do not wear any anything on the
torso, Today, 10 years back. ..frica; Africa
Africa, in India I am telling Bharatpur. Bharatpur is just next door. But if Rakhi Sawant
does it in Mumbai, whole censor board will start. What is unhealthy? What is unhealthy and what is mental health? Somebody doing, a
poor man doing an obscene gesture on the street is mentally ill, you always accept. What
about the item number songs in Bollywood? Are they mentally unhealthy or healthy? If
they are mentally unhealthy and we pay two crore rupees to them, then there is
something wrong with us, right. So, this is very, very difficult to define. In western culture, touching feet, they will
they will not accept it. In our culture, we do
not accept, we do not touch feet, we will, we still get a slap. I still, I am, I am 48 and I
hear from my 70 year old uncle, ., you kids have a problem, bloody grown up beyond
your boots. I still hear such things. This is what happens. This is what I am trying to tell you. Lot of mental health issues are context driven. It is a
fallacy on the part of people who diagnose. It is a fallacy on the part of people who
treat to call everything an illness. Like for me, if you ask me somebody has broken
up in love affair, I would not call them mentally ill
and depression. I know it, this is, this should
happen because this happened to Ghalib. So, he wrote lot of poetry. You do not go and
treat Ghalib. Ghalib was depressed, he was alcohol dependent,
alright. Had you treated
him, what if, would this poetry would have come out? John Nash was called to world psychiatry secretary
association Madrid conference and he stood up and he said, thanks you treated
me, but please do not take away my creativity. If my illness in my creativity, let it be. .ctually, I have seen John Nash also. Yes. .nd once . John Nash one of a mathematician’s
friend came and told him, above all you a person
who has dedicated his life to logic and perfection could say, that you are seen through
sort of .. And John Nash only said, the mathematics comes to me
in the same way .. .Absolutely; absolutely. . dreams. Everything, everything, all big things come
there. Socrates has said it, it is a gift from
God. So, again I am saying, do not get mad. But what I am being trying to say, it is all
context driven. You go to the nude camp, they live nude there. You know, certain area you go and tell
them, that why are you doing this? They will come and say why are you doing this. Osho, you know Rajneesh? He was asked why are you keeping a beard. He said, I am
living naturally, you are living unnaturally by shaving. So, what I am trying to tell, that
this is, there is no answer to it. It is a blur. So, on what basis do we decide somebody is
ill, if it is context driven and if it is mentally
healthy, if after taking dope you are supposed to go crazy. And what is abnormal in that
because cannabis use is very common in villages and all that, right. In your hostel it is
not. In, in eastern UP villages, the mothers used
to give bit of morphine to the kids, so that they sleep in the day time and they can
go and work in the field. Today, if you tell
this. So, that means, it is time and space and everything
besides what is healthy. But we
are still there, we have buttered our forte and we will decide. . .So, what are the facts? Let us, I will tell you the normal facts. Everybody has unique blue
print of personality conditioned by nurture, alright. No confusion in this. Stress is
inherent to living. If you do not have stress, you would not perform. But stress, again, is
good stress and bad stress. What we make of stress determines quality
of life. Simply,
there is some stress, your performance improves. The stress goes beyond a point, your
performance drops. Between this confusion this whole billion
dollar industry is making money, everybody, all the gurus, all self-help
things, all yoga. Barrack Obama has said,
that yoga is a good spiritual exercise and it is nobody’s copyright and all that. So, what I am saying, that what is inherent
and being given to you by nature, by simple mathematics called Yerkes-Dodson curve. Simple mathematics, stress till a certain
level will improve your performance, beyond a certain
level it will fall, simple. There is a
good stress; there is a bad stress. What you make out of your life determines
your quality of life and you do not need rocket science
to understand this, simple. . What are the challenges to living in normal
life? Cognitive aberration, we all have, you
now understand cognitive aberrations, but we all have faulty logics, right. Cognitive
aberrations come by selective abstraction. You, you have given a set of data, you will
see what you want and then get worried, right. Like, you have being told, that you will,
small kids or school kids report card. The report card is the huge selective abstraction. What is
the report card nobody knows, but then what is abstract? The report card is determining .my passing. From here starts the problem, passing, because
more important knowledge gains a second hand. There is cognitive aberration and unfortunately,
cognitive aberration is present not in kids. They do not know all this. It is present in the teachers
and parents. Minimization and maximization, what should
not be paid attention to we bothered too much about it, right, and what should be paid
attention, you do not bother. This is called
minimization. So, these are normal things. Generalization, specific thing, you generally,
all hall 1 drinks alcohol, what, 30 percent would drink and make .. But those 30 percent
can ride over. Politicians, politicians,
this is a typical thing we do. Cognitive aberration, all politicians are
bad, you cannot do this. Please, for God’s sake, 540 MPs cannot be
bad, they are human beings like us. There will be hardly 40 or 60 or 100 at max
will be real corrupt and bad. Who these 100
becomes? These 100 becomes a huge number, rest 400
were poor people who are working. This is generalization actually; this is generalization,
everybody is bad. But this
induces anxiety. Suppression of emotion and thought, we all
do this, is not it. We have to, otherwise we
would not survive. . .What are the sources of all this trouble
to normal people? Let us look at the normal
problems, then we will see whether we turn into mentally ill. Self, we are a problem to ourselves. There is no bigger problem on earth than me,
right. There is a great poet, Surdas. You have heard of Surdas? He used to write poetry on
Krishna. He wrote, that you ought God are you. Till this date you have been saving all
this bloody minor puppies, save me, then I will know you are a God. So, this is in the
mind of human beings from ages. Work, work is a problem always and you have
to work to earn your livelihood. It is not a
good way of living, nevertheless. Relationships are meant for problems; sometimes
support. .

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