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Essay

New Perspectives on Cinema & Mental Health

Between 1990 and 2017 one in seven people in India suffered from mental illness ranging from depression and anxiety to severe conditions such as schizophrenia. However, the depiction of this in cinema has been poor and sensationalist contends Shantanu Ray Chaudhuri.

‘In a lot of films there is the underlying message that all the patient really needs is love and affection. There is a tendency in films to try and normalise mental illness by saying that patients don’t need treatment, they need love. The audience gets the two extremes and what we are not getting are portrayals of people with chronic illness.’ – Dr Cleo Van Velsen, psychiatrist

A poet loses his mental balance on seeing his beloved fall to her death. And what do his family members do? They approach a dancing girl in a brothel to marry him in a bid to get him cured. In a fit of madness, he even rapes her, and she becomes pregnant. But the typical ‘good Indian woman’ that she is, she perseveres in her effort. A few convoluted plot-turns later, the poet gets into a brawl with the villain, resulting in the latter falling to his death, much like his lover. Lo and behold! He is cured, though now he has no memory of the dancing girl.

A nurse in a mental hospital is asked to take care of a patient as part of an ‘experiment’ that its dictatorial army doctor president wants to conduct. The patient is cured but it affects the nurse’s emotional stability. Insensitive to her turmoil, the doctor, preening with the ‘success’ of his experiment, more or less browbeats her into another one with a new patient. With disastrous consequences. Not only is the science/medicine of it dodgy (romantic love to cure a person), it also has the doctor spouting a line like ‘there’s nothing like a woman’s love and care to heal an unstable mind’, while the inmates going around the institute are, in the words of writer and critic Madhulika Liddle, the quintessential Hindi-film, “singing-screeching-long-haired lunatics in films like Khilona, Pagla Kahin Ka, Anhonee, etc”.

These are two of Hindi cinema’s most celebrated films, both huge commercial and critical successes: Khilona and Khamoshi. And both equally and criminally unaware of what mental health entails. Over fifty years later, on the evidence of films like Atarangi Re, Hasee Toh Phasee, Judgemental Hai Kya, Bhool Bhulaiyaa, Anjana Anjani, Tere Naam (in Hindi) and Hridpindo, Habgi Gabji and Bela Shuru (in Bengali), films continue to be as clueless about mental health conditions (MCHs) and how to deal with them.

As Vidushi Duggal, clinical psychologist and co-founder of Accept, says, “Mental health issues are grossly misrepresented in Hindi cinema. First, there is a tendency among filmmakers to select only the more overt (and hence the more ‘dramatic’) MHCs for portrayal, such as schizophrenia, bipolar disorder, dissociative identity disorder to name a few. Second, the lack of proper understanding and research, coupled with creative liberties aimed at sensational dramatisation, manifests as misinformed content.”

Her colleague and co-founder of Accept, Nikita Ramachandran, also a clinical psychologist, adds, “The depiction of mental health, despite advancement in literature, conversations and growing awareness remains largely uninformed. The core of this depiction is a viewing of mental health from the lens of chronicity and severity of illness. The scope of mental health has largely been limited to insidious mental health conditions such as depressive disorders, OCD, schizophrenia, with some focus on developmental disorders such as intellectual disability, autism or learning disorders. This depiction itself poses a problem, due to the association of mental health with illness/disease. The illness-lens fails to consider a fundamental truth – that mental health exists by virtue of being human.”

Leave alone such classic portrayals as A Streetcar Named Desire, Ingmar Bergman’s Persona and Hour of the Wolf, going back to the 1950s and ’60s, to more contemporary ones as One Flew Over the Cuckoo’s Nest, What’s Eating Gilbert Grape, A Beautiful Mind, Silver Linings Playbook, one would be hard-pressed to find one Hindi or Bengali film which addresses the theme with any verisimilitude till almost the new millennium.

There was the odd Mahesh Bhatt film like Arth and Phir Teri Kahani Yaad Aayi. One character that might escape attention when we talk of MHCs is the tenacious cop played by Boman Irani in Jijy Philip’s My Wife’s Murder, which has an interesting and understated subtext linking a food fetish with subtle melancholia.

Over the last couple of decades, films depicting mental illnesses have proliferated, sadly, with little responsibility and almost no understanding. While it is interesting that the films that managed to get some of it right were all made in the new millennium – reflecting a greater awareness about MHCs and greater acceptance in popular discourse – it is equally frustrating that some of the most pathetic films too have been made in the last two decades. As Vidushi Duggal says, “They depict an oversimplified and skewed portrayal of the MHCs in question, replete with stereotypical and insensitive portrayals that are magnified for dramatic effect.”

But this has been par for the course from, say, a Pagla Kahin Ka in 1970 and other films of the era which showed electroconvulsive therapy (ECT) as the cure for all symptoms of ‘madness’, to Krazzy 4 in 2008, where four patients suffering from every disorder possible escape the institution they have been committed to. Their experiences and conditions are then played out for laughs in a manner that is not only insensitive but also offensive.

The Films That Got It Partly Right

Dear Zindagi: That this Gauri Shinde film has been feted in the India media despite its problematic therapist-client relationship says a lot about how starved we are of responsible content. It needs to be applauded for its very nuanced take on mental health (Alia Bhatt[1] is a revelation), with none of the cliches that we are used to. It is also one of the few films that has its protagonist seeking therapy and that depicts sessions with a psychiatrist. As Vidushi Duggal says, “I can think of no realistic psychiatrist in Indian cinema. SRK’s[2] character may come close to a halfway decent portrayal of a psychotherapist in practice, but it too has problematic elements.” One major problem pertains to the relationship between the client and therapist with the latter even taking the former out to the beach for ‘sessions’ and talking about his own failed marriage and relationship with his son. A strict no-no as far as therapy is concerned in real life. As Anupama Chopra pointed out, the film offers a “Vogue version of therapy – a lovely expansive Goa house, sessions during walks on the beach, cycling together and dialogue like har tooti hui cheez jodi ja sakti hai[3]. It’s manicured and pat.”

Taare Zameen Par: This much-lauded film gave us the very real world of a dyslexic child and his relationship with a teacher who recognises his problem and inspires him and people around him to come to terms with and understand the very real gifts the child possesses. Though the child’s trouble with simple arithmetic is more a trait of dyscalculia than dyslexia, it remains a rare Hindi film that has found mention in peer-reviewed academic journals like Annals of Indian Academy of Neurology and Indian Journal of Psychiatry. These journals have praised the film for its general accuracy in depicting dyslexia which “deserves to be vastly appreciated as an earnest endeavour to portray with sensitivity and empathetically diagnose a malady”, blending ‘modern professional knowledge’ with a ‘humane approach’ in working with a dyslexic child. However, it needs to be mentioned that dyslexia is a learning disability and not a mental illness. That the filmmakers club it with other mental illnesses shows how mental health is not correctly understood.

15 Park Avenue: The story of a woman, Mithi (Konkona Sen Sharma[4]), conjuring a utopia in her mind – an imaginary house, 15 Park Avenue, that gives the film its name, happy mother of five imaginary children, wife of an imaginary husband – and living with it, Aparna Sen’s [5]film, shattering and affecting in equal measure, addresses mental illness with a sensitivity and accuracy that almost all Indian films lack. The telling moment when Mithi’s sister (played by Shabana Azmi[6]) tells the psychiatrist (Dhritiman Chatterjee[7]), “What right do we have to take away the happiness she gets from her imaginary world?”, raises an issue that is rarely addressed, the subjectivity of reality: hallucinations can be just as compelling as ‘reality’. Just because someone’s perceptions of reality is at variance from ours, does it give us the right to term the former ‘abnormal’ or object to it?

Death in the Gunj: Konkona Sen Sharma’s directorial debut is another rare film that addresses the unravelling of a fragile mind over a family holiday. Given that the film is set in 1979, an era when there was no conversation around the subject, there is no overt mention of mental health. Also, though Shutu (Vikrant Massey[8]) may be the one who comes across as prone to what could be called mental health issues, the film strips the veneer off the ‘loving family’ to show how we are complicit with our toxic masculinity and bullying in driving a frail mind off the rails.

Other films that got aspects of it right are Black, which despite going over the top in many crucial sequences offers a very nuanced understanding of Alzheimer’s, and Kartik Calling Kartik, one of the first Hindi films dealing with schizophrenia.

The Bad and the Ugly

Tere Naam: Leading the list would be this Salman Khan [9]starrer that featured a mentally unstable protagonist whose head is shaved, and who is tied in chains. The mental hospital sequence in the film is a gratuitous misrepresentation. In a gross failure of messaging, like Shah Rukh Khan’s Rahul in Darr, Radhe Mohan’s obsessiveness, in keeping with the tradition of ‘heroes’ stalking women in Hindi films, is presented as worthy of emulation. One aspect of Hindi films dealing with mental health issues that needs to be called out is the manner in which they position unrequited love/obsession as a trigger, often portraying that as a fashionable antihero statement. Which of course harks back to Saratchandra Chattopadhyay’s Devdas, the original ‘antihero’ who could have done with psychiatric consultation.

Vidushi Duggal says, “While many films have gone on to give this impression, I would be wary of making that connection as it is yet another example of misinformed sensationalisation. Mental health issues are complex and have multiple causal factors – genetic, biological, psychological and social/environmental. Nikita Ramachandran adds: “The depiction of someone unravelling or descending into a breakdown or developing a mental health condition is an inaccurate portrayal, as well as an overgeneralisation that caters to the general theme of love, attempting to add an ‘interesting’ dimension or layer to this portrayal of love. Equally problematic is the manner in which mental health has been pathologised for a long time. Behaviour seen as deviant, classified as ‘abnormal’, characters depicted with mental health issues were villainized. The violent death has been an age-old trope of a satisfactory ‘The End’, where closure has been synonymous with death and a general depiction of ‘good over evil’.”

Bhool Bhulaiyaa: A psychological horror comedy (!) that ostensibly deals with dissociative identity disorder (DID), this colossal hit makes a series of missteps about mental disorders. Hypnosis as a cure for DID, ‘treatments’ rooted in superstition (including a psychological condition that is cured when the doctor slaps the patient), ‘psychiatrists’ who applaud themselves as godmen – it is an endless list of shocking distortions. Akshay Kumar [10] as a psychiatrist. Need one say more?

Atarangi Re: ‘I am a psychiatrist, and I know women.’ That’s a dialogue a doctor mouths and that’s the level of discourse around mental health this film stoops to. In another sequence the doctor clubs together people with bipolar, psychiatrist disorders and schizophrenia in a manner that’s downright offensive. In one sequence, the ‘imaginary’ character Sajjad, a magician, is supposed to make the Taj Mahal disappear and fails to do so only because the patient has popped a pill immediately before the ‘act’. Filmmaker Aanand L. Rai is a serial offender when it comes to woeful depiction of mental health issues, with the protagonists of Tanu Weds Manu Returns shown consulting a marriage counsellor in an asylum! The man describes his wife’s irrational behaviour as an example of bipolarity to which the doctor responds: “In that case, every woman is bipolar.”  

Anjana Anjani: Writing about the ‘hollow space in my heart’ that made her use the term ‘death thoughts’, Therese Borchard says in her blog, “The most difficult thing I will ever do in my lifetime is to not take my life.” That is everything that is wrong Anjana Anjani, where two adults battling life crises enter a pact to take their own lives. A hugely problematic representation that romanticises suicide, it makes a mockery of the breakdown that drives people to such despair. 

Hasee Toh Phasee: The protagonist here, described as ‘mental Meeta’ in the film’s promotional material, blinks her eyes incessantly, twitches her nose, is extremely jittery – all of which are shown as symptomatic of ‘madness’. She is constantly popping pills to control these sensations which lead to odd situations.

The Situation in Bengali Cinema

Such is the paucity of characters dealing with MHCs in Bengali cinema that a few filmmakers I reached out to, could not come up with a single film on the subject. One pointed out Aparna Sen’s Paromitar Ekdin for its realistic and heartfelt delineation of the character of Khuku, a girl with intellectual disability who is referred to as ‘schizophrenic’ by other characters in the film. Uttam Kumar’s[11]1955 film Hrad, based on a novel by Bimal Kar, is another instance of a film that places its protagonist in an asylum. He seems to have forgotten parts of his life and behaves in a manner that make people feel he is ‘mad’. There’s of course Deep Jwele Jaai, the Bengali original of Khamoshi

Three recent films stand out as examples of how clueless writers and filmmakers are when it comes to depiction of MHCs. Shieladityo Moulik’s Hridpindo is the story of a woman who, because of an accident and the brain surgery that follows, is left with her fourteen-year-old self, with no memory of her life after, including her husband. However, her pronounced lisp and the way she behaves, constantly demanding attention, leaves you wondering if she is a child of seven! Not to mention that a film dealing with a brain surgery is called Hridpindo.

Raj Chakraborty’s Habgi Gabji, the title a take-off on PUBG, addresses the very relevant theme of gaming and mobile addiction and its frightening consequences on young minds. Bolstered by a good turn by child actor Samantak Dyuti Maitra, the film, despite its noble intentions, suffers from the same problems that beset many other films of the genre. The child is taken to a psychiatrist. However, the session does not take place in a professional space but in the doctor’s drawing room. There is little emphasis on understanding, prevention and cure, with a large part of the meandering script devoted to the child’s violence and alienation. Which is disappointing given that the WHO has defined gaming disorder as a “pattern of behaviour characterised by impaired control over gaming, increasing priority given to gaming over other activities” and has flagged the escalation of gaming as a major health risk.

Bela Shuru, one of the biggest successes of 2022, is a high-intensity melodrama with a social message, typical of films by the filmmaker duo Nandita Roy and Shiboprasad Mukherjee. It addresses the onset of Alzheimer’s in the elderly but the symptoms that the wife displays – smearing her face with vermilion, among others – is more in tune with lunacy than the more insidious effects of Alzheimer’s. It is obvious that the filmmakers opt for the overdramatic and take creative liberties in the depiction of mental health issues, dumbing down the narrative, in the process bracketing different illnesses under the same umbrella and distorting the truth.

The lack of proper representation in Bengali cinema is also surprising given that its biggest icon, Satyajit Ray, introduced the world to many unheard-of mental health issues in his stories. Nakur Chandra Biswas in the Shonku books, for example, is a psychic who experiences flashes of the past and future. Barin Bhowmick-er Byaram is the story of a kleptomaniac who has been through therapy. The protagonist of Bipin Chowdhury-r Smritibhrom suffers from a curious case of memory loss, while Fritz explores the childhood trauma of its 37-year-old protagonist. In the Feluda story, Dr Munshi-r Diary, we have a patient who suffers from a persecution complex, an irrational fear or feeling that one is the object or target of collective hostility and persecution. What is fascinating is that Ray wrote about these conditions decades before they became part of the public discourse in India. However, none of these were adapted into cinema.

The Responsibility of Filmmakers and Writers

It is critical to note that cinema plays a significant role in shaping, creating and developing one’s understanding of reality. Films have of late started investing in an intimacy director/coordinator. Maybe it is time to have good psychiatric consultants too. Nikita Ramachandran says, “Mental health and emotional well-being are nuanced, and every story is different. It is challenging to depict the many layers, and also portray these in ways that will resonate or connect with the larger audience.” Vidushi Duggal is of the opinion that, “While acknowledging that an exhaustive depiction of all nuances of mental health is beyond the scope of a time-limited medium that is essentially designed for entertainment, as a community we need to remain cognizant of the potent and pervasive influence of cinema on creating awareness and developing/shaping attitudes. This calls for responsible filmmaking that involves adequate research on the mental health issues being portrayed.”

(Note: For Vidushi Duggal, who listened. Nikita Ramachandran, thank you for your inputs.)

A shorter version of this essay was published in Telegraph earlier

Shantanu Ray Chaudhuri is a film buff, editor, publisher, film critic and writer. Books commissioned and edited by him have won the National Award for Best Book on Cinema twice and the inaugural MAMI (Mumbai Academy of Moving Images) Award for Best Writing on Cinema. In 2017, he was named Editor of the Year by the apex publishing body, Publishing Next. He has contributed to a number of magazines and websites like The Daily Eye, Cinemaazi, Film Companion, The Wire, Outlook, The Taj, and others. He is the author of two books: Whims – A Book of Poems(published by Writers Workshop) and Icons from Bollywood (published by Penguin/Puffin).

[1] Indian film actress

[2] Indian film actor, Shah Rukh Khan

[3] Translates from Hindi as: “all broken things can be repaired”

[4] Actress and Director

[5] Actress and Director

[6] Actress

[7] Actor

[8] Actor

[9] Actor

[10] Indian film actor

[11] Actor (1926-1980)

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Categories
The Observant Immigrant

When is a mental illness not a mental illness?

By Candice Louisa Daquin

Shakespeare’s King Lear: Was he mad or grief stricken? Courtesy: Creative commons

Depending upon the country you live in, you may have to think back a long time or not so long, to imagine a time when talking of mental illness wasn’t mainstream. For many countries mental illness is still a taboo, but the internet has made knowledge of mental illness more wide-spread. You could be forgiven for thinking most people suffer from some form of mental illness. In reality, statistically, the majority do not. Most of us however, go through hard times where we may exhibit behaviour shared with those suffering from mental illness.

Having just finished co editing a large book on mental illness, I began to think about how we swung from one extreme (never acknowledging mental illness) to another (talking about it all the time). As a psychotherapist this isn’t perhaps surprising but the extent to which we label and evoke mental illness as explanation, might be.

Sometimes atypical behavior isn’t mental illness.

Teens, the elderly, the dispossessed, so many groups may suffer what seems like a mental illness but it really a natural response to a challenging situation. The adjustment of growing up. The challenges of getting older. Losing partners. Losing parents. Hormone changes. Trauma. Treating these events, the same way you would someone with a long-term mental illness like schizophrenia is ignoring the difference between an illness and a causative episode. With health insurance companies demanding categorisation in order to approve insurance, there has been a gradual shift toward ever-increasing terminology and labels. The problem with this is someone going through depression because they lost a parent can be seen as mentally ill — just like someone suffering from severe schizophrenia. But the two are not the same. We must be careful not to confuse malaise and regular responses to trauma and challenges, with a deep-rooted illness that might not be as curable. Why? Because we’re no longer understanding crucial differences in what we deem mental illness.

Therapists and medical professionals can be far too quick to state unequivocally that someone is mentally ill. This matters because just as ignoring mental illness and not talking about it, is wrong, so is over diagnosing it. The reason being, when you label someone, you set into motion years sometimes of inaccurate diagnosis and treatment which can do more harm than good.

Before you dismiss this as a rare event, think again.

Here are some case studies (real names not used) I have come across in my work:

John was told he was bipolar and was sent to an outpatient ‘group’ in a local residential center for mentally ill people. This was on the basis of his arguing repeatedly at his place of work and finally being fired. He also had several car accidents that he put down to ‘feeling angry’ and he attacked his wife during an argument. He was prescribed high dose psychotropic medication and his insurance was charged for the expensive therapy he received daily.

His family were horrified to find out their father was ‘suddenly’ mentally ill with bipolar disorder ll in his late sixties. They didn’t question the authority of the doctors until it became obvious something else was going on. At that time, he had sunk into a deep depression and seemed to be losing his ability to drive. The family asked the psychiatrists whether he could have dementia, to which they were repeatedly told — no he’s mentally ill. Firstly, this is an erroneous way of describing a condition as blanket-diagnosing mental illness, and second, they were wrong. John had the beginning of Alzheimer’s and his delayed diagnosis caused great heartache for everyone involved.

The question of how any competent psychiatrist could have diagnosed John with Bipolar ll which rarely if ever ‘suddenly happens’ late in life, is but one example of how a system will fit a diagnosis to its dominant perspective, in this case an assumption that certain behaviours are always congruent with a mental illness. John like many with Alzheimer’s did share some symptomology but nobody bothered to consider an alternative diagnosis and thus, the incorrect medication, expense and uncertainty caused a sad diagnosis of Alzheimer’s to become even more protracted and painful. Equally it should be mentioned for the sake of fairness, that there is an over-abundance of dementia-related diagnosis of older people where other causes are not considered and this is the same shortsightedness.

Liza, was diagnosed with schizophrenia based on muted affect, spells of catatonia and trauma response as well as insomnia, severe anxiety and depression. She exhibited paranoia and fearfulness as well as despondency and out bursts of anger. Even if those symptoms could fit the diagnosis for schizophrenia, they are too generalized to be assumed as such. Nevertheless, Liza was given EST (Electric Shock Treatment) and institutionalised for years, without another diagnosis being considered. It turned out Liza had never had schizophrenia but after years of medication it was hard to tell what was causing her behaviour. It wasn’t until years later when she began to open up to a therapist who cared, that Liza found out her symptoms were the reactions of severe childhood abuse and sexual abuse. These had never been considered because she was not asked about sexual abuse, and did not volunteer about it (most sexual abuse survivors don’t). It was easier to medicate her and inflict EST on her, than really understand what was going on. Liza went on to live a full life, but with the scars of her experiences and a deep mistrust of the psychiatric field (rightfully!).

These are two of many, many stories I could share of clients with misdiagnosis histories that caused them and their families a great deal of suffering. Of course, there is the flipside of people not being diagnosed with a mental illness and equally suffering and I acknowledge that happens too. The purpose of this essay is to consider the epidemic of over-diagnosis and how, maybe with good intention, we’ve swung from one extreme (nobody is mentally ill) to another (if in doubt, it’s a mental illness).

Whilst I am the first person to say accurate diagnosis and treatment can save lives when it comes to the mental health field. I have seen how doctors and practitioners can be subject to the undue influence of social trends in diagnosis and medication and how this can influence the accuracy of their diagnosis. Psychotropic drugs can have life-long effects which if that’s your only choice compared to the misery of a mental illness, you will accept, but what of those who didn’t need them in the first place? My concern is the over-medication and over-diagnosis of certain kinds of mental illness set a cascading storm into motion.

A colleague of mine who works as a psychiatrist had her own experience of being on the ‘other side’ when she developed a sudden onset illness. The illness included heart palpitations. My colleague went to the ER with chest pains thinking she might be having a heart attack. The physicians on call determined she wasn’t and their next recourse was to suggest it was an anxiety related issue. They prescribed anxiety medication and recommended she saw a therapist. My colleague went another appointment only to find out she was sitting in front of a psychiatric nurse. Despite her own qualifications as a psychiatrist, she said at the time she felt vulnerable, unsure of what was happening and very afraid. She explained her feelings of fear to the nurse, alongside her concern that she had no definitive diagnosis. The nurse did not refer her to another medical doctor for further tests. She recommended heavy duty anti-anxiety medications.

Because my colleague is a psychiatrist, she had the presence of mind to decline but it got her wondering what would have happened had she not been clued into the failings of the system? She could easily have been taking strong medications for a ‘suspected’ case of anxiety, without really finding out what was wrong and caused her heart palpitations. It took my colleague a long time to finally get an answer. A rare disease. With treatment she recovered. The lesson she learned however, terrified her. She now understood how at the mercy of doctors most patients were and how often diagnosis wasn’t a precise science or even an educated guess, but more of a ‘by rote’ method that was deeply flawed.

She showed me the thirty something bottles of medications she was given with every appointment and explained that had she been truly suffering from a serious mental illness, she would have had more than enough to overdose with, even given the safety protocols of modern medicine. She also explained the ease with which she was given extremely powerful drugs, without a documented diagnosis and how many side-effects those medicines potentially had. She is now an advocate for change, hoping the medical industry and the pharmaceutical industries can be cautioned against rash diagnosis and over-medicating. It worries me that it takes an expert in the field to raise a red flag and I remain pessimistic about her success in changing a well-oiled system that earns billions in kick-backs and profit from the perpetuation of an illness rather than a cure.

Getting into hospital unless you have a heart attack or amputated limb isn’t easy any more. The model is more about treating patients and sending them home. This works for many, and expands on the ‘care in the community’ concept with mental health (which has floundered since inception, creating huge groups of homeless mentally ill) but does not work for everyone, especially those with harder diagnosis. Consequently, many of us have learned what it feels like to be a patient going through a broken system, what you had to do to get what you needed and how hard that would be if say, you were in the throes of a serious illness (be it mental or physical). Some doctors are responsive, caring and compassionate, whilst others merely check a box. The inadequacy of systems set up to help both the physically and mentally ill is underfunded and the level of treatment often fractured, in favour of cost-saving protocols that were often unapplicable to those they served. How challenging must it be for patients to seek good help during some of the hardest times of their lives?

I have sympathy for the over-worked/under-paid GP/family doctor who is restricted by insurance protocols and limited in what they’re able to offer their patients. I understand how it may seem easier to offer an anxiety medication or label someone bipolar, than spend weeks trying to get to the real cause. But you don’t heal anyone with a wrong diagnosis, and you mar the field of psychiatry by misdiagnosis. It’s no wonder I’m often mistrusted as a mental health worker, because so many of my patients have had negative experiences of being judged, marginalised and labeled, by previous psychotherapists and doctor. It only takes one person to assume you’re not coping and must be clinically depressed, to set into motion a whole chain of events. What if that practitioner had looked beyond the obvious and considered the evidence more closely? But sometimes it’s easier to reach for the prescription pad. You are doing someone a disservice if you medicate a vulnerable person on the basis of basic symptoms rather than looking at the whole picture. It’s a catch-22 situation with such short appointment times and a burgeoning patient load.

In prisons, where a high number of inmates have mental illness that are not treated through accessible programmes, drugs have become the surrogate for competent therapy. It is simply cheaper to drug a patient than offer 1-1 therapy. Whilst it may not be fiscally possible to offer low-cost or free therapy to everyone who needs it, we shouldn’t use drugs as a substitute if they’re not the answer. Most psychotropic drugs were designed to be used short-term but many people take them for years. If you imagine some of those people could be misdiagnosed or not really suffering from a mental illness so much as a hard time that will resolve, then you’re responsible for drugging people who shouldn’t have ever been drugged. How is this an answer to anything?

In nursing homes, patients with dementia and other diseases often take over ten medications that ultimately won’t cure anything but will make the pharmaceutical industries rich. The reason? To keep them compliant and calm. So they won’t bite, make a fuss or tax the underpaid staff. Again, I can sympathise with wanting to medicate a troublesome patient, but in shrugging everything off to mental illness we lose touch with the real cause and effect and shirk our responsibility to accurately treat people. Maybe with fewer doctors and ever-increasing medical costs this is no longer possible, in which case as more of us age and get dementia or alzheimer’s, expect to see a steady increase in the use of psychotropic medication as a means of management.

I have met many who have had similar sudden onset, long lasting catastrophic illnesses. Many of them were told by doctors that these illnesses were psychosomatic or psychiatric in origin when it turned out to be a hundred percent physical. Whilst I don’t deny that some illnesses can be psychiatric in origin, many are not and women are far more likely to be told their illness is ‘in their head’ or ‘an issue of nerves’ – and this not just from the medical industry, but their families and friends. Like anything, when you’re in a dark place it’s very easy to convince yourself, the doctor is right, which can further exacerbate misdiagnosis and unnecessary suffering and stigma.

For the seriously physically ill, this is as bad as having a heart attack and being told ‘you are anxious you need to calm down’. It is counterproductive and often causes people who need help not to seek it. The blurring between the physical and the mental is unacceptable. Whilst there is clearly a mind-body link, assuming everyone with anxiety must be mentally ill (rather than anxious for a good reason) is short-sighted and potentially damaging. Likewise, labeling every woman histrionic because she’s panicking about something, is using mental illness categories as a weapon.

The gender divide between how doctors treat female versus male patients is a long-standing inequality, based upon the old concepts of hysteria (a female term applied toward women only) and the link between mental instability and the female body. Whilst it is true that menstruation, hormones and menopause can definitely change a person’s mood, this is not the same as true mental illness and it is high time we understand the difference between feeling anxious or depressed and suffering from clinical depression or anxiety. The only way we achieve this is by quitting our tendency to label certain groups without further enquiry. This includes women, people of colour and lower-income persons — all of whom are more often assumed to be mentally ill than other groups.  

The harm of a misdiagnosis is, as I said earlier, as bad as no diagnosis. The rush to come to a conclusion is something that turns into a scarlet letter for the bearer. Despite our best attempts, mental illness is still stigmatised, and as such, once diagnosed, this can affect everything from future job prospects, marriage, friendships to even housing. In the information age, medical privacy is constantly under assault, and even future employers are able to find out about people’s private lives. Should they discover that person has a mental illness that they stereotype as being negative, this could reduce a person’s equal chances. The old adage, ‘crying wolf’ also applies because we over-diagnose and popularise in unhealthy ways. That causes people to shirk when someone really does need help.

Why do we stigmatize the mentally ill? I often hear from clients who are overmedicated and some who are undermedicated, both extremes existing because one provokes the other. A lot of psychotropic medication is not effective and placebo at best, leaving the medical industry with a big question mark as to how to help the mentally ill. Whilst I don’t have all the answers either, I would say, ensuring someone is really mentally ill before acting on it, is one positive step toward reforming a broken system. Currently so much money is spent on mental illness but people are not getting better, they are getting sicker. That means something really isn’t working. I’m not convinced the recent move to online psychiatry is the answer either, given the danger of powerful medications. I’m also not convinced strong medications like Ketamine and Ecstasy should be given without close monitoring. I’m all for creative thinking in medicine, but not without caution.

Finally … when is a mental illness not a mental illness? We should be open to alternative diagnosis rather than the category of mental illness as a catch all for when we’ve no better answer. Just because something isn’t apparent, doesn’t mean it’s a mental illness. There is so much the medical industry doesn’t know and often it takes patience and commitment to discover a rare disease. If we didn’t spit people out and try hard to see as many people as we could, we might have time to discover the real cause and not send people home with incorrect medication. It’s damaging and it further stigmatises those who really need mental health treatment. On the other hand, sometimes feeling anxious is just feeling anxious, and not something to pathologise. We will all feel depressed or anxious at times, it doesn’t mean we need a category and our current system doesn’t seem to have another option. How about we start with asking the patient – what do you think is going on? Often, we learn the most from our patients, and they will help us know whether they have a mental illness or are just going through a hard time. The difference between providing short-term supportive care and getting someone on a life-time of strong medication is huge and we need to have our eyes wide open.

Candice Louisa Daquin is a Psychotherapist and Editor, having worked in Europe, Canada and the USA. Daquins own work is also published widely, she has written five books of poetry, the last published by Finishing Line Press called Pinch the Lock. Her website is www thefeatheredsleep.com

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