Alone with the mental demons?

Seema is 62 and lives in Mumbai. Till about 16-17 years ago, she was a vivacious person with an enviable education, who had chosen to remain unmarried. The turning point in her life came when she decided to live alone in a secluded place for a few years. At first, she felt homesick. This was followed by acute loneliness, until one day, she was found screaming and weeping. Seema spent two days in a ward for the mentally ill before her family reached her. At 47, she was diagnosed with schizophrenia. Visits to a psychiatrist led to a course of antipsychotic drugs but the medication made her feel lethargic and sleepy and resulted in weight gain. She felt ugly and imagined that people were conspiring all around her. Seema's confidence hit rock bottom but her family refused to let her sink. She managed to hold on to her lecturer's job at a local college for eleven more years, after which she was given a fond farewell. Even today, she guides her Ph.D students.

Seema is almost cured thanks to the medicines and her family's unflinching support. But there are many women who suffer mental breakdowns with mood disorders like anxiety and depression.

The book Psychology of Women devotes an entire chapter to this issue. It says that there are large gender differences in patterns of the rates of mental disorders, the largest gender gap being in anxiety and mood disorders (World Health Organisation 2000, 2004). Studies have shown that diseases such as autism, Parkinson's and motor neuron disorders afflict more boys than girls. Women suffer more often from mood disorders like depression and anxiety. These can be temporary but if sleep and appetite are affected, leading to over or under-eating, then the condition is termed clinical depression, where a person's mood is pervasively low.

The book further adds that although genetic and biological factors are in some way responsible for the risk and expression of mental diseases in women, the reasons are also strongly rooted in social conditions like hunger, lack of economic resources (work that earns low wages) and gender-based violence such as sexual and physical abuse.

Exposure to adverse life events is another contributing factor. As Dr Geetha Desai, Associate Professor at the Department of Psychiatry at NIMHANS, Bangalore, puts it, “If the woman has a biological or genetic predisposition to a mental disease, then there are more chances of her suffering from that disease, given a set of environmental factors. For instance, a woman with a history of mild depression has a greater chance of developing postpartum depression.”

Depression in women

Oral contraceptives, menstrual disorders, menopause, hypothyroidism or relationship problems are just some of the factors that could lead to depression when a woman is vulnerable, says Dr Geetha.

Depression can develop during the postpartum period of a new mother. It can be for a short period, commonly referred to as ‘baby blues' or can continue for long, with the feeling of tiredness, unexplained weeping and apathy towards the surroundings and the infant. In severe cases, the mother may even feel suicidal or aggressive towards the baby. “The hormone and metabolic changes, child birth, sex of the child, attitudes as well as support by the kin, all influence the risk for mental disorder,” explains Dr B.N. Gangadhar, Professor of Psychiatry at NIMHANS. Not everyone gets postpartum depression but women who have a history of mild depression and are in stressful family relationships or have had a difficult childbirth, are the likely victims.

Dr Krishna Kale, former Head of Department of Anaesthesia, Govt Medical College, Nagpur, says that some studies suggest that depression may also occur after a woman has had surgery following anaesthesia. There is some association between women who undergo heart surgery and their risk to brain injury and strokes. Being HIV-infected, too, could result in psychiatric disorders as a psychological consequence of the infection or because of the effect of the HIV virus on the brain. Disorders may be as varied as depression, post-traumatic stress disorder, AIDS phobias, grief and the whole gamut of cognitive disorders. Another common cause of depression in women is obesity. Take Bangalore-based Rita, 38. Though extremely talented, she has studied only till the tenth standard. She has always been obese — no amount of walking seemed to help — and today, she is battling mild depression. She is married for two years now but has not been able to have a baby. Doctors say that she could be suffering from Polycystic Ovarian Disorder (PCOD) because of her obesity. While PCOD does lead to hormonal changes and depression, Rita has accepted obesity as a way of life. Depression apart, women also commonly suffer from Obsessive Compulsive Disorder (OCD) and dissociative disorders or hysteria (as it was earlier called). Equally common in men and women, it is a physical manifestation of the disorder in the brain. There are also possession disorders, where a person believes she is a Goddess when she visits a temple.

Treatable illnesses

Shanti, who is in her early sixties and lives in Nagpur, has developed OCD over the years. She always felt her hands were dirty and would repeatedly wash them. Today, her condition has reached such a stage that her hands are always wet! The good news for Shanti though is that OCD is curable by counselling. In fact, most mental illnesses are treatable. But the key is to understand that treatment is no longer like how it's been illustrated by the famed book and film One Flew Over the Cuckoo's Nest (Written by Ken Kesey, it is a story set in an Oregon asylum, and serves as a study of the institutional process and the human mind). Dr Harish T., Assistant Professor of Psychiatry at NIMHANS, says, “Maybe, when the book was written in 1959, conditions in mental health were similar elsewhere but it is not anything like the book today.”

Treatment for postpartum depression, he adds, consists of anti-natal check-ups, medicines and electroconvulsive therapy — where the brain is stimulated by the passage of electric current through it. It is done under anaesthesia. Depression and mood disorders are tackled with medication, psychotherapy and cognitive behaviour therapy, which involves treatment based on emotions and behaviour. Dr Gangadhar feels that “with or without causes, depression can be treated”. Both medication and yoga can help. Patients may choose either drug or no-drug treatment. If the condition is severe, then electroconvulsive therapy is preferred.” His research has shown that practise of sudarshan kriya has had great benefit to some of his patients. Disorders like OCD, Dr Kale says, can be treated with counselling and very rarely needs medicines.

Stress may trigger mental illnesses in women but it is important to know when to seek help. Indian society is conservative and conditions that can be cured during the early stages are often neglected till it becomes too late. And, of course, “along with medication and various kinds of therapy, it is the support of a close-knit family that pulls an individual from the darkness of mental ill health and makes them well again,” says Dr Prabha Chandra, Professor of Psychiatry at NIMHANS.

© Women's Feature Service

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