“ ……..so doctor, I want my son to learn to swim at any cost.
Do anything and reduce his fear of the pool…..” The child in question is 4 years old
“……… we should now ask Psychiatrists to step in and do some
counseling to provide stress management to the Police force so such incidents
do not occur……” response to a recent case of fratricide
“……….this happened because they don’t have regular full-time
counselors and Psychiatrists on campus……” response to the student suicide on
campus of a premier engineering institute
On the one hand, Psychiatrists have to face stigma and
people do not like to take their advice where due. On the other hand are
instances where Psychiatrists are seen as a panacea for all behavioral and
social problems- as the above examples show. Psychiatrists also sometimes get
carried away and try to get involved in things that should do not fall in their
jurisdiction. So it is very important to understand the limits of Psychiatry.
What can Psychiatrists do, actually?
Psychiatrists are trained to treat mental illness. Most
training programs cover only treatment with medications. So strictly
Psychiatrists should restrict to treating only disorders with medications. No
patient ever recovers merely by ‘spending time’ with a Psychiatrist. There are
other people to spend time with, even for a fee.
What do Psychiatrists need, to work?
The other common myth is that Psychiatrists can work in a
vacuum, without any facilities or instruments. But a Psychiatrist needs a
quiet, safe sound proof room to work. Basic instruments like BP instrument,
weighing machine, height measure and basic neurological exam instruments are
needed. Every Psychiatrist needs the assistance of clinical psychologist,
counseling psychologist, social worker, counselor and receptionist. Without the
inputs from these people Psychiatric interventions remain disorganized,
incomplete and become excessively medicalised.
Who should meet a Psychiatrist, really?
I have always felt that people should try to meet their
family doctor or counselor first and then meet the Psychiatrist if recommended.
But in India- the poor training and unscrupulousness of primary health care
workers makes me recommend ‘ when in doubt meet a Psychiatrist’. This is said
with the hope that the Psychiatrist will be well trained and honest. Unless
there is a clear mental disorder or your Psychiatrist is trained in
Psychotherapy- there is no role for Psychiatrist involvement. But Psychiatrists
have one advantage- they are invariably trained in methods of diagnosis and at
least you can find out what is wrong with you.
Social problems and Psychiatrists?
Psychiatrists cannot solve social problems based on their
training and professional degree. The correct scientific method to solve a
social problem is to study it from different angles- find solutions from
different disciplines and then involve Psychiatrists only to treat mental
illnesses.
So to the above 3 vignettes, I will say
‘….whats the hurry to teach him to swim. Let it go, now. Try
again when he grows up. Bring him for treatment when he grows up and realizes
that his anxiety is a problem and he is willing to learn how to deal with it…..”
“ several excellent studies on causes of stress in the
Police force have already been done. I can cite the study done by Dr S K
Chaturvedi of NIMHANS, Bangalore.
So commission a similar study for this particular Police
force. (And please don’t tell Psychiatrists to do this study; better trained
professionals are available). I doubt if
there has ever been an attempt to screen applicants for mental sturdiness
before inducting them into the force.
Find out what stresses the Police. Remove those stresses which are
amenable to removal. And teach stress management for the stress that cannot be
removed. For example- police reforms have been pending for ages. Housing
facilities are pathetic. Solve these
problems. Catching thugs is stressful- teach them to deal with this.
It is ridiculous to believe that Psychiatry should teach
people to perform and stay healthy under inhuman conditions manufactured and
maintained by an insensitive system.”
“…..students are conformists and rebellious at the same
time. I don’t think students are going to accept mental health specialists
telling them what to do. Hostel students’ parents blame the college for causing
stress, whereas colleges blame parents for pressurizing students- eventually troubled
students become nobody’s responsibility. Clear administrative guidelines need
to be formulated to deal with such situations. I don’t believe that a premier
institute with a fully functioning department of humanities cannot put together
such a protocol for their institute. What can a Psychiatrist do when an
underage student comes alone for help? Actually it is illegal to treat a
student without expressed consent of the parent or guardian.”
