Mental health in Tamil cinema

Tamil cinema is a vibrant part of the lives of many in south India. A chequered history and a phenomenal growth have made this medium highly influential not only in Tamil Nadu politics, but also in the social lives of the viewers. This paper provides an overview of the growth of Tamil cinema, and discusses in detail the way mental health has been handled by Tamil films. Cinema can be used very effectively to improve awareness about mental health issues.     

Malayalam cinema and mental health

There is a tradition of using films to teach various aspects of psychiatry and we feel that Malayalam cinema can also be used suitably to teach effectively. These films can be an invaluable resource in cultural competency training as they depict the effects of culture on psychopathology and cultural and regional influences on attitudes to mental illness and stigma. We also note that the portrayal is often far from reality but this is not a barrier for using the films as an effective alternative to traditional and didactic teaching methods. This method of teaching can stimulate interest and discussion and demystify the myths of novice students and others about mental health.     

Insight in people with psychosis: The influence of culture

The assessment of insight is a part of the routine clinical examination for people with mental illness. Such assessment, by psychiatrists, is based on the current definitions of insight, which rely on western notions of health and illness. This paper discusses the recent findings of explanatory models of people with a variety of physical diseases in Vellore, India. It also summaries the results of studies on insight in schizophrenia, which examined explanatory models of illness among patients, relatives, and the general population, in Vellore. The findings argue for the fact that the assessment of insight should be against the local cultural standards rather than universal yardsticks.     

Insight in people with psychosis: the influence of culture

The assessment of insight is a part of the routine clinical examination for people with mental illness. Such assessment, by psychiatrists, is based on the current definitions of insight, which rely on western notions of health and illness. This paper discusses the recent findings of explanatory models of people with a variety of physical diseases in Vellore, India. It also summaries the results of studies on insight in schizophrenia, which examined explanatory models of illness among patients, relatives, and the general population, in Vellore. The findings argue for the fact that the assessment of insight should be against the local cultural standards rather than universal yardsticks.     

Attitudes of mental health professionals toward people with schizophrenia and major depression

Several studies reveal poor knowledge about mental illness in the general population and stigmatizing attitudes toward people with mental illness. However, it is unknown whether mental health professionals hold fewer stigmatizing attitudes than the general population. A survey was conducted of the attitudes of mental health professionals (n = 1073) and members of the public (n = 1737) toward mental illness and their specific reaction toward a person with and without psychiatric symptoms ("non-case" as a reference category). Psychiatrists had more negative stereotypes than the general population. Mental health professionals accepted restrictions toward people with mental illness 3 times less often than the public. Most professionals were able to recognize cases of schizophrenia and depression, but 1 in 4 psychiatrists and psychologists also considered the non-case as mentally ill. The social distance toward both major depression and the non-case was lower than toward schizophrenia. However, in this regard, there was no difference between professionals and the public. The study concludes that the better knowledge of mental health professionals and their support of individual rights neither entail fewer stereotypes nor enhance the willingness to closely interact with mentally ill people.     

Mexican Psychiatric Trainees’ Attitudes Towards People with Mental Illness: A Qualitative Study

Despite their training, psychiatrists have been found to have negative attitudes towards people with mental illness, including the patients they treat. Similarly, studies focused on service users have identified psychiatrists as a source of stigma. Even though negative attitudes in psychiatrists have been identified in different countries and settings, in Mexico the attitudes of these professionals have never been assessed. Because of this, we invited psychiatric trainees from a hospital in Mexico to participate in individual interviews to describe their opinions regarding mental health-related stigma, to evaluate their attitudes towards people with mental illness and to identify factors that could be influencing their attitudes. Interviews were audio recorded, transcribed and analysed using thematic analysis. A total of 29 trainees participated in the study. The results suggested that trainees recognised psychiatrists can have negative attitudes towards people with mental illness, such as poor empathy, judgement and labelling, and mainly towards patients considered difficult and with borderline personality disorder. Participants recognised these attitudes can influence their relationship with patients, and considered it is necessary to develop interventions to improve their own attitudes and reduce mental health stigma. From this study we concluded Mexican psychiatrists are not free from stigma towards people with mental illness. However, Mexican psychiatric trainees are interested in improving their attitudes and reactions towards their patients.

     

The cure of souls: psychiatric dilemmas

Misunderstandings quite frequently occur between patients and their doctors because psychiatrists may be unable to comprehend and therefore accept their patient's experience. 'Soul' and 'spirit' are essential characteristics of human life: soul ultimately means 'quick moving', the principle of life; spirit etymologically refers to breath and is also the animating or vital principle.The spiritual aspects of a person include his or her aims and goals, the interrelatedness of human beings, wholeness of person in which spirit is not separate from body or mind, moral aspects of goodness, beauty and enjoyment and an awareness of God. Psychiatrists have historically had difficulties with the spiritual realm, some of the roots of psychiatry have been anti-ecclesiastical and currently psychiatrists are well aware of the harmful effects of some religious groups upon vulnerable patients.However, religious people, those who regard faith, religious practice and spiritual issues as important, have had distrust for some psychiatrists and their publications.There has also been a degree of professional rivalry between clergy and psychiatrists who share some of the same goals for their parishioners/patients. Patients feel themselves sometimes to have been caught in the cross-fire and this has resulted in reluctance to talk about spiritual issues to their psychiatrists or mental health problems to their priest.In practice there is considerable evidence for the benefit of religious belief in achieving good mental health and recovery from mental illness.It is important for the psychiatrist to be aware of patients'religious beliefs and spiritual aspirations, to understand these and know about patients' backgrounds. It is harmful for psychiatrists to try and impose their own views and understandings upon their patients.     

Mad tales from Bollywood: the impact of social, political, and economic climate on the portrayal of mental illness in Hindi films

OBJECTIVE: To study the portrayal of mental illness (especially psychosis) in Hindi films since 1950 and to study the influence of prevalent social, political and economic factors on each portrayal. METHOD: Using two encyclopedias and one source book, films that had mental illness affecting one of the protagonists were identified. The social, economic and political factors were identified using history texts. RESULTS: In the 1960s after India became a Republic, the political climate was one of idealism and as a result the portrayal of mental illness was gentle, more international in its outlook, and used psychoanalytic techniques. In the 1970s and 1980s, as a result of increased political and bureaucratic corruption and an unstable political climate, the portrayals became harder and psychopaths were portrayed more often. In the 1980s, the trend continued with female psychopaths, and avenging women emerged as a major force because the political and judicial systems were seen as impotent in delivering justice. In the 1990s, following economic liberalization, the women were seen and used as possessions in society and the cinema, and portrayals of stalking and morbid jealousy increased. CONCLUSION: Hindi films since the 1950s appear to have been influenced by changing cultural norms which in turn affected the way mental illness is portrayed.     

Holding the patient to account at the gatekeeping stage

Underlying the arguments against hospitalisation of some mentally disordered offenders, and violent offenders in particular, is the fear that such people are ‘getting away with it’ or that the psychiatrists have been ‘duped’ . There may be some justification for these concerns in that health service staff often have a very muddled approach to concepts of responsibility among their patients. This in turn can confuse the patients and be counter-therapeutic. Among staff it can foster unduly authoritarian approaches of dubious morality. A proposal is presented for a much more objectively enquiring approach to patient behaviour, with rational, reasoned responses, which may include prosecution under the criminal justice system. Such approaches are not incompatible with hospital treatment, whether as an inpatient or outpatient. While these approaches may be applied to a patient with any mental disorder, including a psychotic illness, they are perhaps of particular importance in relation to those patients with an antisocial personality disorder, for whom limits must be clear and the appropriate establishment of personal responsibility is so important.     

The interface of physical and mental health

Purpose

The interaction between physical and mental health is complex. In this paper we aim to provide an overview of the main components of this relationship and to identify how care could be improved for people with co-morbidities.

Methods

We performed a literature search of MedLine, Ovid and Psycinfo and identified studies that examined the association between mental illness and physical illness. We also examined the key policy documents and guidelines in this area.

Results

People with mental health conditions are at higher risk of developing physical illness, have those conditions diagnosed later and have much higher mortality rates. Conversely, people with a diagnosis of physical illness, especially cardiovascular disease, diabetes and cancer have a greater chance of developing a mental health problem. When both mental and physical illnesses conditions are present together, there are higher overall rates of morbidity, healthcare utilisation, and poorer quality of life.

Conclusions

Physicians and psychiatrists need to be aware of the co-occurrence of mental and physical health problems and the challenges posed for both general and mental health services. There is a need to screen appropriately in both settings to ensure timely diagnosis and treatment. Liaison psychiatry provides psychological assessment and treatment for people with physical illness, but there is a gap in the provision of physical healthcare for people with severe mental illness. There is a need for public policy to drive this forward to overcome the institutional barriers to equitable access to healthcare and for educators to reverse the tendency to teach mind and body as separate systems.     

Social Distance and Community Attitudes Towards People with Psycho-Social Disabilities in Uttarakhand,India

Stigma is an important contributor to the large treatment gap for people with mental and psycho-social disabilities (PPSD) in India. Social distance as assessed by willingness to engage in relationships with PPSD is a proxy measure of stigma and potential discrimination. In North India, investigations of community attitudes towards PPSD have been limited. To describe attitudes towards people with depression and psychosis, a community sample of 960 adults in Dehradun district, India from 30 randomised clusters, was surveyed using a validated tool to assess social distance, beliefs and attitudes related to mental illness. Participants preferred greater social distance from a person with psychosis than a person with depression. Beliefs and attitudes around mental illness were diverse reflecting a wide spread of belief frameworks. After controlling for confounding, there was increased social distance among people who believed PPSD were dangerous. Factors that reduced social distance included familiarity with PPSD, and belief that PPSD can recover. Attitudes to PPSD, stigma and social distance are complex and likely to require complex responses that include promoting awareness of mental health and illness, direct contact with PPSD and increasing access to care for PPSD.     

The public image of psychiatrists

The image of psychiatry is directly related to the knowledge that the public has of psychiatry and to the psychiatrists role as a "public informer". The time has come for psychiatrists to organize and have their opinions on all aspects of the mental health care system and mental illness heard in the media. After a review of different causes of the negative public image of psychiatrists, the reasons for which psychiatrists need to change their public image are outlined with some suggestions for increase public recognition. The importance of developing more research on the effect of mass media on the mental health care system is also outlined.     

Health Services Delivery by Shamans

Mental health services in Pakistan are still in the developing stages with less than 300 psychiatrists for a population of more than 140.5 million against the background of a low literacy rate, stigma, and the high cost of psychotropic medications that have disturbing side effects. Shamans are alternate therapists in whom people invest faith, and they approach shamans in growing numbers seeking cures from mental ill health. These therapists act as good counselors and in a way help the health system indirectly. Such therapists have a different concept about causations of mental illness and their treatment approaches are unique. This article examines health service delivery by these shamans against the background of Pakistan’s socio-economic system, and also identifies the need for collaboration with these therapists.     

Mental health and spiritual values. A view from the East

Psychiatry and psychiatrists often forget the value and role of spirituality in the life of their patients.This paper deals with the interrelationship of mental health and spirituality in India and using illustrations from Hinduism suggests that Indian system does not follow theWestern concepts of mind-body dichotomy. Furthermore the Hindu view of life includes righteousness, biological needs, social needs and release from worldly bondage and union with ultimate reality.The dangers of ethno-centricity in reaching clinical diagnosis and managing patients with mental illness across cultures are highlighted.The clinician must be aware of scientific progress but without giving up the role of religion.     

A mental health training program for community health workers in India: impact on knowledge and attitudes

Background

Unmet needs for mental health treatment in low income countries are pervasive. If mental health is to be effectively integrated into primary health care in low income countries like India then grass-roots workers need to acquire relevant knowledge and skills to be able to recognise, refer and support people experiencing mental disorders in their own communities. This study aims to provide a mental health training intervention to community health workers in Bangalore Rural District, Karnataka, India, and to evaluate the impact of this training on mental health literacy.

Methods

A pre-test post-test study design was undertaken with assessment of mental health literacy at three time points; baseline, completion of the training, and three month follow-up. Mental health literacy was assessed using the interviewer-administered Mental Health Literacy Survey. The training intervention was a four day course based on a facilitator's manual developed specifically for community health workers in India.

Results

70 community health workers from Doddaballapur, Bangalore Rural District were recuited for the study. The training course improved participants' ability to recognize a mental disorder in a vignette, and reduced participants' faith in unhelpful and potentially harmful pharmacological interventions. There was evidence of a minor reduction in stigmatizing attitudes, and it was unclear if the training resulted in a change in participants' faith in recovery following treatment.

Conclusion

The findings from this study indicate that the training course demonstrated potential to be an effective way to improve some aspects of mental health literacy, and highlights strategies for strengthening the training course.     

The portrayal of ECT in American movies

OBJECTIVE: To describe the portrayal of electroconvulsive therapy (ECT) in American films. This has not been systematically studied previously, despite some notorious ECT scenes in the history of American cinema and the impact of films on audiences. METHOD: All movies depicting or making reference to ECT were identified from a number of sources. Available movies were viewed on at least two occasions. RESULTS: 22 films, beginning with The Snake Pit and ending with Requiem for a Dream, portraying or making reference to ECT were made between 1948 and 2000. 20 (91%) of these movies were obtained and viewed. CONCLUSION: Having commenced its movie career as a severe but helpful remedy for personal distress, ECT on film has become a progressively more negative and cruel treatment, leaving the impression of a brutal, harmful, and abusive maneuver with no therapeutic benefit.     

Perceptions about psychosis and psychiatric services: a qualitative study from Vellore, India

Each culture influences the perceptions of illness and pathways to health care that its members follow. Non-biomedical beliefs about psychosis and treatment are reported from the developing world. This study explored people’s perceptions on psychosis to understand local perceptions of the condition. Focus group discussions were conducted with people who have relatives with psychosis (in five focus groups), with members of the general public (in four focus groups), and with patients who had recovered from psychosis (one group) in Vellore, South India. These discussions were recorded, transcribed and analyzed. Participants recognized psychosis as an illness category, and viewed indigenous healing methods as complementary to allopathic treatments. Multiple and apparently contradictory beliefs on different aspects of psychosis were often simultaneously held by participants. People in the community were more likely to express negative views about mental illness. Relatives of patients with psychosis wanted more support from mental health professionals and community in combating stigma against mental illness. Results of this study reveal the complex nature of illness perspectives among patients with psychosis, their relatives and community. Bio-medical and indigenous beliefs are simultaneously held by a significant number of people who often seek help from both modern and traditional health systems at the same time. The results indicate the need for better understanding of local perceptions of psychosis.     

Stigmatizing Attitudes About Mental Illness and Allocation of Resources to Mental Health Services

This study tests a social psychological model (Skitka & Tetlock, 1992). Journal of Experimental Social Psychology, 28, 491-522; [1993]. Journal of Personality & Social Psychology, 65, 1205-1223 stating that policy maker decisions regarding the allocation of resources to mental health services are influenced by their attitudes towards people with mental illness and treatment efficacy. Fifty four individuals participated in a larger study of education about mental health stigma. Participants completed various measures of resource allocation preferences for mandated treatment and rehabilitation services, attributions about people with mental illness, and factors that influence allocation preferences including perceived treatment efficacy. Results showed significant attitudinal correlates with resource allocation preferences for mandated treatment, but no correlates to rehabilitation services. In particular, people who pity people with mental illness as well as those that endorse coercive and segregated treatments, were more likely to rate resource allocation to mandated care as important. Perceived treatment efficacy was also positively associated with resource allocation preferences for mandated treatment. A separate behavioral measure that involved donating money to NAMI was found to be inversely associated with blaming people for their mental illness and not being willing to help them. Implications of these findings on strategies that seek to increase resources for mental health programs are discussed.     

A review of the interplay between tuberculosis and mental health

Aims

Tuberculosis and mental illness share common risk factors including homelessness, HIV positive serology, alcohol/substance abuse and migrant status leading to frequent comorbidity. We sought to generate a comprehensive literature review that examines the complex relationship between tuberculosis and mental illness.

Methods

A literature search was conducted in MedLine, Ovid and Psychinfo, with further examination of the references of these articles. In total 316 articles were identified. It was not possible to conduct a formal meta-analysis due to the absence of randomised controlled data.

Results

Rates of mental illness of up to 70% have been identified in tuberculosis patients. Medications used in the treatment of common mental illnesses, such as depression, may have significant interactions with anti-tuberculosis agents, especially isoniazid and increasingly linezolid. Many medications used in the treatment of tuberculosis can have significant adverse psychiatric effects and some medications such as rifampicin may reduce the effective doses of anti-psychotics y their enzyme induction actions. Treatment with agents such as cycloserine has been associated with depression, and there have been reported cases of psychosis with most anti-tuberculous agents. Mental illness and substance abuse may also affect compliance with treatment, with attendant public health concerns.

Conclusions

As a result of the common co-morbidity of mental illness and tuberculosis, it is probable that physicians will encounter previously undiagnosed mental illness among patients with tuberculosis. Similarly, psychiatrists are likely to meet tuberculosis among their patients. It is important that both psychiatrists and physicians are aware of the potential for interactions between the drugs used to treat tuberculosis and psychiatric conditions.