by Marcus Tan
“MENTAL” illness, for want of a more accurate and less derogatory adjective that allows us to better conceptualise the nature of these conditions, is as old as mankind.
For much of human history, psychiatric conditions were often considered to have supernatural or paranormal origins. Those afflicted were thought to be under the influence of black magic or possessed by evil spirits. Many treatments before the 17th century were based on occult practices that often led to their recipients in a worse off state. As early as the 8th century, the first psychiatric treatment facilities were set up. However, these institutions served more the purpose of containment or confinement. They offered little more than space to contain persons’ behaviours. Treatment, if any, was empirical by large and seldom based on robust medical evidence.
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Psychiatry, as a discipline in medicine, was proposed in 1808 by Professor Johann Christian Riel, a German physician. The word psychiatry itself derives from the two greek words psyche, meaning soul or mind, and iatros, meaning physician. From then, systematic effort, utilising scientific methods was undertaken to study disorders of human behaviour. This pivotal move heralded the development of modern psychiatry. More humane therapies and focus on public education soon followed.
Despite so, there remains much more to be achieved.
Misconceptions about psychiatric conditions and their treatments continue to abound. These range from notions that people with these conditions are “crazy”, “odd”, “bad” or “weak minded” to them never getting well. Despite advancements in treatment, psychotropic medications and even psychotherapy continue to be very much maligned. Medications do not alter personality or rob a person of his / her identity. Apart from a small handful of situations, one cannot be compelled to receive treatment. Psychotherapy is more than “just talk”. Conversation is but an avenue through which rapport is built so treatment can be effected.
What is Psychiatry?
Psychiatry is one of the most, if not the most, misunderstood fields in Medicine. There are few disciplines that have attracted as much controversy.
Misinformation and the consequent misunderstandings about Psychiatry have resulted in the stigmatisation of its receivers of care, the care providers and its practice. More importantly, this stigma has led to apprehension towards help seeking and delay in treatment. Unnecessary, avoidable prolongation of personal physical and emotional distress aside, the individual’s social and occupational functioning are not spared too. With compromised coping abilities, the person can find him/herself overwhelmed by his/her circumstances. These circumstances can be predisposing, precipitating or perpetuating factors that contribute to the origin(s) of illness, which is often multifactorial.
With the world moving at an ever-accelerating pace, most of us already struggle to keep up and can ill afford “down time”. The individual with lesser than usual functional capacity to cope can find him/herself stranded and lost. Unhealthy compensatory or self-help behaviours e.g. harmful addictions or recreational drug use can occur. These behaviours, while offering short term escape, certainly do not help improve the situation in the longer term. A sense of loss of control ensues and ultimately worsens the distress experienced.
Despite emphasis on early help seeking, it is not uncommon in day-to-day clinical practice to have persons come forth to seek help only after long periods of being ill. By this time, it is not unusual for the individual to find that his/her work, relationships, and life have suffered appreciably. These individuals let on that they perceive themselves as “weak minded” and feel shame or even become guilt-ridden in their help seeking. It should not have to be so.
Being distressed is not a sign of weakness. As it has been aptly put, distress occurs only when one has been too strong for too long a time. Only when one has put in his/her best effort, can he/her become exhausted.
Occasional media reporting that sensationalises public displays of behavioural aberrations or suggests an association between criminal or offensive acts and psychiatric conditions do not help. While it is convenient to attribute these behaviours or acts to psychiatric conditions, in reality, these are more related to poorly controlled or untreated symptoms, which arise out of delay in seeking treatment, if there indeed is a presence of an illness in these cases. Ironically, it is not the condition, but the lack of treatment that has led to the outcome. Suffice to say, this misinformation that leads to wrongful association must stop.
With the advent of technological advances in the 20th and 21st centuries, physicians have been able to achieve a clearer understanding of the disease process behind some psychiatric conditions and the complex interactions between an individual’s environment and innate factors that result in symptom production. These advances, which include higher resolution brain scans and functional imaging, have also aided the development of medical therapies, while far from ideal, that are safer, more targeted and effective.
At present, it is agreed that a combination of medical, psychological and social therapies are indicated for the treatment of most psychiatric conditions to achieve the best outcomes.
Hence, how do we define modern psychiatry?
Psychiatry is the branch of medicine which is concerned with the understanding, assessment, diagnosis, treatment and prevention of disorders of emotions, behaviour, perceptions and thinking. These disorders predominantly present with behavioural symptoms that occur due to a complex interaction of biological, psychological and social factors. It should not be construed simply as a disease of the mind and/or brain. Treatment is tailored and focused on the person, at times the significant others, within the context of their environment.
We hope that through the course of this series, we can help provide insight into the work healthcare workers do for psychiatric conditions, how assessment is carried out and common psychiatric conditions and their treatments. It is hoped that this information will help bring about better understanding of Psychiatry and promote prompt help seeking. Perhaps you will find out too that psychiatric conditions are not so different from other medical conditions managed by our colleagues in other disciplines.
Dr Marcus Tan is a psychiatrist with 18 years of experience in clinical practice in both public and private healthcare. Together with his partners, he runs Singapore’s longest standing community private psychiatric clinic in the heartlands. He also volunteers with the Singapore Armed Forces and serves as a medical assessor on the Medical Board of the Civil Aviation Authority of Singapore. He believes strongly in mental health literacy and sees it as key to improving awareness and decreasing stigma towards psychiatric conditions and persons with them.
Featured image by Sean Chong.
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