When should one see a psychiatrist?
Bollywood (and Hollywood) lore suggests that people seeking psychiatric help are either so violent that they need strait-jacketing, or they are blathering idiots unable to take care of themselves. It’s the simplistic black and white world of the movies where people are divided into two kinds, the normal and the barmy. While most of us know that this isn’t quite true, we might still be surprised to know of the broad spectrum of behavior requiring psychiatric treatment. It’s not just illnesses like schizophrenia and obsessive-compulsive disorders that need treatment but also depression, anxiety, panic attacks, addictions, eating and sleeping disorders, and borderline personality disorders.
Not all sufferers seek help, either because they feel they can cope, or because they think that going to a psychiatrist is a sign of weakness or…madness. This is far from the truth. ‘Most people who visit a psychiatrist these days work, get married, and function as respectable citizens in society,’ says Dr. Bhupesh Velaskar, psychiatrist. The important thing is to recognise the symptoms and seek treatment before there are unpleasant consequences.
It’s possible to recognise the tell-tale signs. For example if a person feels low and disinterested in life, isolates himself from people and has thoughts of death, he needs help. At times a person maybe consumed with powerful emotions like violent rage, racking guilt, or intense jealousy, and the inability to control these emotions results in conduct unacceptable in society, like aggression, hostility and even violence. At times it’s an acute lack of self-esteem and feelings of rejection which cause self-destructive behavior. All this emotional distress can result in a lack of concentration and judgment. ‘When relationships and work is affected because awareness of oneself and surroundings is defective, behavior is bizarre or uncontrollable, judgment in social situations is off the mark, and you perceive things which others don’t, you need help,’ says Dr. Velaskar.
Psychological problems can manifest themselves in physical symptoms as well. ‘Aches, pains and severe exhaustion can be a symptom of depression,’ says Dr. Harish Shetty, social psychiatrist. Palpitations, sweating, tightness of chest can be caused in a panic attack. Sufferers do not hesitate to rush to their GP with such symptoms because it’s alright to admit to a migraine or constipation, but not to depression. And when treatment fails, it’s the family doctor who has to gently tell the patient to see a mental health professional.
People who have never had a psychological illness are the last to realise that they need help, specially if the distress they suffer is triggered by an external event like loss or trauma, or is caused by another person’s behavior. ‘Some psychological problems are caused by loss of a loved one through death, separation, divorce, loss of expectation (cannot have a baby), loss of job or because of physical incapacity due to illness or accident,’ says Ameeta Sanghavi Shah, psychotherapist. When people resist recognising that they need help they can make their situation worse ‘with use of escape measures like addictions or somatize their feelings with body aches, fatigue, head-aches or project their problems on others,’ says Shah.
As a first step a sufferer can seek treatment from a therapist. A therapist helps identify the internal and external factors that contribute to the problem and also such internal and external factors that can help relieve the problem. At times however she has to direct the patient to a psychiatrist. ‘If the person is not responding to counselling, and symptoms endanger the well-being of oneself or others, if the person has suicidal thoughts, is unable to eat, rest or work, then he might need medication. In this case he has to see a psychiatrist,’ says Shah. Psychiatrists not only provide psychotherapy, they carry out diagnostic evaluations, assess physical problems, and if needed prescribe medications and arrange hospitalization.
Serious mental illnesses like schizophrenia where there are clear biological components, can only be treated by psychiatrists. Ofcourse to some extent, every psychiatric problem is influenced by the genes. ‘A mental illness is always an interplay of the genes, environment, age, type of stress and the support system available,’ points out Dr. Shetty.
Once one recognises that a psychiatrist’s office is not a place where the weak or crazy go for shock treatment or sedation, that it’s a place of refuge, a place where one can unburden one’s soul, then it becomes easy to go there. Even normal people like you and me might need to do that, at some point in our lives. No one is immune. Not celebrities. Or successful professionals. And well, if you can run to the doc at the hint of a sniffle, why not when your mind is under strain? It’s only when you get the help you need that you can lead the life you deserve, and live it to the fullest.
(Published in The Times of India in 2005)