MENTAL HEALTH LIMITS, PRIORITIES AND PSYCHOETHICS

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Presented at 35th Annual Conference of Indian Psychiatric Society at Bombay on 7th January, 1983. •Professor of ... psychiatrist must act as a consultant as ... changing world a need to krow and act ... gambling dens, in the saloons of the ele-.
Indian J. Presidential

Psychiat. (1983), 25(1), 3—6 Address

MENTAL HEALTH LIMITS, PRIORITIES AND PSYCHOETHICS JAYA NAGARAJA* M.B., D.C.H., D.P. (Canada), DWPA (England) D.H. (Canada) FIMSA T h e Congress this year is memorable because it marks the incoming of its L a d y President and those ladies who h a d gone before m e were very prestigious women doctors who we:e the torch bearers of the Indian Psychiatric Society; it is memorable also because it is being held in Bombay which is hailed as the New York of India, beset with beauty, business a n d bustling activity. T h e intervening years h a v e been kind to us. They have seen a tremendous growth in the Association under the leadership of others from a mere handful of members to a very encouraging current figures. Even though there have been a few ups and downs, displeasure a n d disappointments yet all these years have slowly slipped by making its mile-stones of progress due to the unflinching endeavours of its offke-beaiers a n d I am proud to know t h a t my n a m e too would go down in the annals of the history as one of its presidents. Currently I a m glad to say that there h a v e been impressive change? in Psychiatry. T h e n u m b e r of Psychia trists a n d para-professionals involved in M e n t a l Health p r o g r a m m e have increased a n d the n a t u r e of services delivered have also improved after opening d e p a r t m e n t of Psychiatry in few of the general hospitals attached to Medical Colleges. A basic amou.it of Psychiatric knowledge is being imparted to medical students a n d majority of the institutions do h a v e post-graduate courses in Psychiatry. Yet while insti-

tutions which were little more than w a r e houses for the unloved, uncared a n d u n wanted a n d discarded personalities h a v e virtually disappeared almost all over the western world, we still h a v e M e n t a l Hospital with poor staff p a t i e n t r a t i o and at times run by non-psychiatrist. With a modest improvement in public a t t i t u d e towards m e n t a l illness m e r e a n d more patients a r e reaching the portals of a mental hospital which remain illequipped; poorly staffed a n d n o one seems to take cognisance of the increased d e m a n d for Psychiatric services. T h e growth a n d improvement of these hospitals a r e a t a very low e b b d u e to problem of health c a r e financing a n d d u e to a long r a n g e of tiresome, unfulfilling, frustrating rules, Government policies a n d paper-work. T h e future of Psychiatry in our country still looks bleak a n d clouded, though we h a v e come a long way in other medical fields. T h e criticism levelled against Psychiatrist a n d Psychiatry is iconoclastic a n d Psychiatry in India still faces crisis, criticism, controversy a n d confusion. 1. Let us tarry a while and contemplate on the proper limits of the speciality a n d how best can our scarce resources b e utilised more effectively. 2. H o w a n d w h a t efficient methods can b e employed to help such of those people which the society shuns a n d points out as "Loosers in the g a m e of life" ? a n d 3. W h a t a r e the ethical a n d moral standards t h a t would govern the Psychiatric enterprise ?

Presented at 35th Annual Conference of Indian Psychiatric Society at Bombay on 7th January, 1983. •Professor of Psychiatry, Andhra Medical College and Superintendent, Govt. Hospital for Mental Care, Visakhapatnam—Andhra Pradesh.

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Equipped with answers for these the Government can he awakened into activity to support the Psychiatric movement in t o o , bring into awareness the importance of its services, be it in leaching hospitals or in M e ttal Hospitals, and mobilize them for belter mental h e a b h financing system. When all the different branches of medicine and surgciy are receiving m a x i m u m support, why is it that mental h e i l i h movement is not gaining any momentum, and why is it that there is total lack of awareness on the part of Government to improve this branch of speciality. T h a i is because these issue; are too seldom discussed by us and we as a body of Psychiatrist do not, practice psychoeihics. T h e development of moral character a n d values among psychiatrist is very important. In developing a frame-work of psychoethics, the rights and responsibility oi' patients, of (heiapist and the socie'y as a whole must be considered. This c a t be gradually achieved only if all the psychiatrists had a wo;king framework and build up an interdisciplinary ethical system which is i:ow sadly lacking. It is said with n o exaggeration that the entire world is the catchment aiea for present day psychiatry. T h e gap between the few who are receiving psychiatric c a r e and the need of the millions is one of the g r c u e n cicditability of psychiatry today. Moreover, in our country it is the chronically sick, and socially iinmau a g e t b l e , the rc;arded, the dementic and the unwanted get the care, a care from which the e h u m a n personnel can never get benefits, a care for which colossal scientific knowledge is going into disuse, while ihosc who are in real need of psychiatric help, counselling, therapy, are not receiving the help they i c e d . This is because (1) L i c k of proper establishment of psychiatric setting (2) a serious problem of maldistribution of professionals with a higher concentration in the metropolitan centres (3) Lack of proper planning as to

the distribution of the existing specialised resources. Services of psychiatric specialists like Doctors, Psychiatric Social Workers and Psychiatric Nuises are utilised in ron-psychiatric aieas while psychiatric hospitals are beirg filled by untrained individuals. M e n t a l Hospitals are kept over-ciovvc'ed and understaffed and psychiatry itself h:is been bclcvelled by low standards. This again comes under the perview of t i e Government policies. It would be ideal if ll e psychiatric specialists aie placed in the traditional psychiatric domain and their services be available as consultants to general practitioners and others. Maxim u m benefits can be had if there is interdisciplinary or team-work approach to problems of mental illr.es. If there is a concentration of all mental health personnel in the different psychiatric units a i d mental hospitals then a large scale o f p i o b lems of h u m a n anguish can be tackled successfully. Contribution from psychiatrist to o'her front lire workers who deal with troubled people is etsc-itial. A psychiatrist must act as a consultant as well as concentrate on more ;evere psychiatric cases and alio cares that involve medical, psycko'ogical and social factors. T h e care giving responsibilities must b e shared with o.her profesionals. This is where the liaison psychiatiy comes which is very meagrely developed in India. O u r other professional colleague must be sufficiently m a d e aware of this facility and one should understand that r.o subject is more clearly beyond the frontiers than mental health. There is always a misconcept regarding " M e n t a l H e a l t h " . FA - en today the euphemism " M e n t a l H e a l t h " is being used for " M e n t a l H i r e s ' . Positive mental h e i l t h is different from the mere absence of mental illness and bo h mental health a n d mental illness need priority support. M a n y of the problems affecting people today are characterised by a lack

MENTAL HEALTH LIMITS, PRIORITIES AND PSYCHOETHIGS of meaniugfulness in their lives r a t h e r than something t h a t can be labelled as illness per c e. O n e can see t h a t there is a rise in cultism, violence, crime, vandalism, dropouts, faddism, alienation, rebellion against a u t h o r i t y including p a r e n t figures a n d dependence on drugs a n d alcohol which in turn depend on fist changing social, cultural, ethical and m o r a l patterns. M a n has always asked the question a b o u t himself, about meriting of life and d e a t h H e has been elated or frustrated in o n e time o : the other of his life a n d he needs simple logical answers to ease the chill in his h e a r t than psuedo scientific philosophies, quasi technological cults and m e ssage; from Me.siahs. M a n ' s desperate search for m e a n i n g and order within a universe of dizziling, accelerating a n d changing world a need to k r o w and a c t is acute. It is here that the psychiatrist should mobilize his resource;, draw m a n from fake stop-gap systems a n d lead h i m through true life style; which is termed the Mental H e a l t h Programme. At a time w h e i t h e m e t t a l h e a l t h of the country should have been oa priority list, t h e S t a t e Governmen ts have failed to provide the leadership it should. Instead it turns a deaf ear a n d a blind eye to the legitim a t e needs of its people. Tiie political responsiveness towards mental health inspite of knowing the rising costs of medic a r e has been very poor, budgeting a n d funding temains age old, response cold, a n d it looks as if denial is the sheet anchor. T h e problems of mental h e a l t h and u p keep of such ho;pitals and centres which try to doll-out mental c a r e should b e solved by sound reason a n d n o t by denial a n d running away, from it. Psychiatric social work, psychiatric nursing, research in the field remains in its infancy a n d will remain so unless actively supported by the Government. Recognition of the problem, active involvement and funding by Government is most necessary. O n e must be sensitive to t h e

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needs of the aged a n d underprivileged, children, minority groups a n d the section of the society w h o a r e viewed as "Life's Loose rs". T h e association a t this j u n c t u r e has a vital p a r t to play in future development. Better public u n d e r s t a n d i n g of the role of psychiatrist is of i m p o r t a n c e , a better understanding of t h e discipline by t h e Government is also of prime i m p o r t a n c e in order to develop modern psychiatric service;. We h a v e a duty to speak o u t clearly in order to clear the cloud surrounding this discipline. O u r association should m a k e proposals which would help p r o m o t e better mental health c a r e in our country. W e must see that the skills of psychiatrists a r e utilised appropriately, effectively and economically and n o t b e bogged a n d constricted by baseless rules a n d regulations set by politicians a n d people w h o h a v e n o clear concept of the perspective of psychiatry. Psychiatry is a scientific a n d ethical discipline, a n d not a n affective ventuie. It deals w i t h the most integral part of h u m a n life, based on personal faith of a patient on therapist, on a secure interpersonal bond, a transference situation a n d there is n o right to a n y one to intervene and disrupt this h u m a n bond, ask a psychiatrist to shred his h u m a n patient in terms of nerves, brain and chemical composition, but allow him a freehand to be the repositor of his patient's faith, develop his own plans and treatment methodology to suit t h e individual a n d give h i m the confidence to follow a comfortable life style. Each h u m a n individual is a n anatomical and physiological mosaic, a psycho'ogical composite, the result of hereditary shuffle of traits. H u m a n being is not a mere passive product of compliance with trcditional ways. Every individual represents a n e w synthesis of the biological urges and the environmental pressure. Such a complex system is being dealt with by a psychiatrist a n d

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it is essential that h e should be free to m a n i p u l a t e the mind. I am reminded of J u n g ' s words where h e directs psychiatrists to wander with h u m a n heart through the world. T h e r e in the horrors of prisons, lunatic asylums a n d hospitals, in the d r a b suburban pubs, in brothels and gambling dens, in the saloons of the elegant, in socialistic meeting, revivalist gathering and estatic sets, through love a n d h a l e , through experience of passion, through every form of body one would reap rich stores of knowledge than pouring over books, and such of these should know how !o doctor the sick with real knowledge of the h u m a n soul. So it is not the legislation or rules t h a t makes psychiatry or a psychiatrists b u t h u m a n e m p a t h y and understanding of what is called the " H u m a n Mind. Mind is a mysterious form of matter of the brain. Its chief activity consists in the e ideivour to ascertain its own nature, the futility or the a t t e m p t being due to

the fact t h a t it has n o t h i n g but itself to know itself says Ambrose Birce in 1842 and we are t h e custodian of this mysterious matter that often seeks help. Let, as Albert Schweitzer p u t s it " H e r e a t whatever h o u r you c o m e you will find light, help a n d h u m a n kindness" b e our motto. A Psychiatrist approach to a h u m a n individual a n d his problems should b e with courage, confidence, cheerfulness a n d compassion. If we can couple these q u a lities with knowledge w e would be able to care a n d cure the population more effectively. Let us n o t b e torn with jealousies, petty personal gains, intra psychic conflicts a n d let us as a prestigious association rise above these and go fotward with strong psychoethics and courage, wage a crusade against malpractice and establish a programme stable M e n t a l Health scientifically. Let us r o t allow everyone to d a b with our speciality and pose themselves as Mind healers.