Mental Illness — All You Need To Know
It is common to find relatives of a mentally ill person who follow the patient to the hospital point a finger to the head and twist the wrist back and forth to the doctor to indicate that the person is mentally ill.
This is normally in response to the question why the patient was brought to hospital. When the doctor begins asking the mentally ill questions to get a diagnosis, the relatives will quickly interrupt and say “he is sick upstairs.”
Often one gets the impression that many people, including some health professionals, think mental illness is one disease.
I wonder how many people will go to the eye specialist that they have an eye problem and expect that straight away without a question he will start treating as if eye problem is of only one type.
This is not possible because eye diseases are many and different, and there are some conditions of the eye which are actually problems of other parts of the body, not the eye at all. In the same way not all abnormal behaviours are necessarily mental illnesses. Some may even be a problem for the surgeons.
The World Health Organisation (WHO) defines mental health as 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 own community.
There are many mental disorders and they are classified by World Health Organisation (WHO) under 10 broad groups.
The first sub-group in the classification is reserved for mental conditions with the cause traceable to a general medical condition. This usually involves diseases of the brain.
Mental disorders are generally considered as diseases of the mind. The mind is the functional aspect of the brain. The brain has ordinary functions like seeing and hearing.
Interpretation of objects seen, such as letters or photographs, and that of sounds as speech or music are all functions of the mind.
The second sub-group categorises disorders related to the use of mind-altering (psychoactive) drugs like alcohol, cocaine, heroin, marijuana (wee) and sleeping tablets. The use of any of these psychoactive drugs on regular basis is a disorder.
Some of the disorders start the first day one uses a psychoactive drug while others occur with chronic use.
The next sub-group is associated with disorders involving abnormal beliefs. One of the most severe mental disorders, schizophrenia is classified here.
Another sub-group is disorders involving the loss of control of mood. With this disorder, the individual may become overly sad without the ability to feel pleasure and is referred to as depression.
The other extreme is when the individual is over happy or easily angered. Normal life involves normal variation of mood depending on the occasion but when one mood persists mostly for weeks then that becomes abnormal. Persons with mood disorders may also hold abnormal beliefs.
Anxiety and stress related disorders are in one sub-group with its management usually posing a challenge in Ghana.
This is mainly because they normally present with physical symptoms such as low grade fever, bitter taste in mouth, fatigue, headaches, muscle pain, general body aches and many more. They produce symptoms in essentially all organ systems in the body.
When people present to their general doctors, diagnosis has to be made by exclusion of all possible general medical conditions. This will increase health cost.
After diagnosis, a referral to a psychologist or psychiatrist may be necessary which the patient will usually refuse because they do not “feel mad”.
The general doctor may not have to give any medication for such a condition and risks being perceived as bad doctor as he or she cannot prescribe many drugs or only prescribe simple drugs. You risk losing your clientele if in private practice.
The other interesting sub-group is that concerned with eating disorders, sleep disorders and sexual disorders. How many people will accept a referral from their general physician to see a psychiatrist for sexual disorders?
Again, here too, doctors are quick to treat a non-existing medical condition with medication or risk losing their clients to an alternative medicine practitioner who claims to have cure for such mental disorders.
Some people have personalities that make them unable to co-exist peacefully with other people without necessarily causing distress to themselves or others.
This includes psychopaths who cannot have empathy and those who are pre-occupied with every little detail in their life and as a result achieve very little and cannot stand “disorderliness” from others.
Three of the sub-groups are for mental disorders with childhood onset. These include stammering, wetting bed at night, learning difficulties, truancy at school and hyperactivity with or without inattention.
There are childhood mental disorders where the children are not able to achieve the mental capacity necessary for their social development. These are generally referred to as mental retardation or sub-normality.
Epilepsy, the tendency to get unprovoked fits or seizures, is a disease of the brain and not a mental disorder even though it can cause a mental illness. Most psychiatrists in Ghana treat a lot of epileptics by default as the public send them to the psychiatric hospitals.
Mental health is not merely the absence of mental illness. Mental illness is not synonymous with madness. Neither mental health nor physical health can exist independently.
Mental, physical and social functioning are interdependent. The broader view of health to involve physical, emotional and social well-being should be the norm and not the exception. The mind and the body are inextricably related. A dysfunction of one affects the other inevitably.
Dr Eugene Dordoye is a Psychiatrist and a member of the health education and advocacy unit of the Ghana Medical Association.