Fault lines in the debate over mental illness

01 November 2013

Srinivas* was referred to the psychiatric ward of Gandhi Hospital in Secunderabad after a failed suicide attempt—the third time in three years that he had tried to take his life. He was diagnosed with clinical depression and put on therapeutic medication, drugs that would work on the delicate network of synapses in his brain to stimulate the production of neurotransmitters such as serotonin and norepinephrine—chemicals that help transmit impulses between neurons and play a role in the regulation of the body’s many mechanisms. The psychiatrist asked him to return for a consultation three weeks from then. The three weeks were a trial, both physically and mentally. Srinivas felt queasy much of the time; he couldn’t sleep, and he had a constant dull headache. The doctor had warned him in passing of some side effects, but he didn’t know how long they would last. The anxious atmosphere at home and the increasing sense of distance from his parents didn’t help much. He showed up at the hospital a few days into the medication and asked to see his doctor. Instead, he was referred to a part-time counsellor. Over several sessions with the counseling psychologist, he came to understand that the medication was necessary, that the side effects would abate over time, and that there were ways in which to move his life forward.

His story wasn’t unusual: a broken romantic relationship, low self-esteem, and difficulties in articulating his needs and problems to his parents. These problems, the counsellor felt, had to do with those relational dynamics and his inability to handle them.

This was one of the rare cases where psychiatry and psychology were applied in a complementary manner to deal with a mental health issue, bringing together the science and art of dealing with the demons of the mind. While the medication was necessary to activate the production of what some call “happy hormones”, the counseling helped him gain perspective and build in him the inner strength to look at his life more positively.

But where exactly does the locus of mental illness lie? In that vague, unfixable entity called the mind? Or in the cellular composition of brain tissue? Can it be better addressed by considering the biochemical basis of life and its constituents or by understanding the social and cultural dynamics that construct and constrict an individual’s life? Does one electronically prod and diagram the convolutions of that intricate tissue, one of the last frontiers of medical science, or listen and watch as an individual life unfolds through narration and description? Are the causes understood within the chapters of biology, by reading personal history, or by examining the existential reticulum of society, polity and culture?

Historians would point to René Descartes and the acceptance of the mind-body duality as the point of separation between these two applied sciences of the mind—psychiatry and psychology. The first is born out of biology and medicine, a belief system that holds that disease has a physical basis, one that can be identified, isolated and observed, given the right tools. The second is born out of a philosophical tradition of enquiry, of a focus on the invisible and the immaterial side of being, the idea of self, the soul and its struggles to find balance in a material world. To which of these disciplines does the health of the mind belong, then? If the mind is merely an extension of the body—a function of the brain, so to speak—then it may be treated with the tools of biological medicine. But if it is beyond the body, then what might the tools of healing be? It is in the application of these sciences to the healing of mental illness that a variety of confusions become apparent—regarding the locus and cause of disease, the path and form of treatment.

Usha Raman is a journalism teacher, writer and editor based in Hyderabad.

Keywords: psychology psychiatry mental illness