All in the family

Source: The Lancet

The debilitating effects of mental health diseases and the social stigma associated with them are not limited to patients: the lives of family members also change irrevocably. Family support can also be an important source of strength and even help in the healing process, say psychiatrists, patients and their relatives.

Reshma Magar from Sindhuli, brought her 35-year-old son to a mental health clinic in Kathmandu after he displayed symptoms like severe headaches, mouth fizzing, and haphazard running around. As a mother, she was constantly worried he might hurt himself.

“We have the Sun Kosi River nearby and I would think: what if he jumped?” says Magar, who has to tie him up in the hospital bed to contain his violent behavior. “I would be crying and the nurses here would console me.”

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Nabina and Samira Pradhan shared similar hardships. Their brother, 40, started showing erratic behaviour after his wife left him, taking their daughter with her. He throws things around, does not eat, and their 71—year-old mother has to look after him.

“It is very hard,” Nabina says, “mother herself has health issues and because of our brother’s state, violence in the home remains a constant danger.”

Sufferers of psychotic mental illnesses are generally unaware they have a problem. In schizophrenia, a severe psychotic disease, patients have a distorted sense of reality − hallucinations, extreme paranoia, hearing voices − that their mind infers as truth. They resist help, and family members have a difficult job coaxing them to seek and continue medical treatment.

Beyond this, the emotional trauma of having a suffering relative is a constant feature of life for the Magar and Pradhan families, which makes each day frightening and unpredictable.

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Research has shown that patients suffering from psychosis have various structural and functional abnormalities in the brain. Schizophrenia patients have dysfunctions in their neurotransmitter systems, metabolic pathways and certain structures in the brain regulating motor activity.

Traditionally Nepali society, which did not have coping mechanisms, regarded mental disorder as a curse, and there is strong social stigma and ostracisation of both the patients and their families. Derogatory labels for ‘crazy’ people like ‘dimag khuskeko’ or ‘pagal are still widely used.

However, now that science has shown that the causes are mostly chemical imbalances, there is treatment says Basudev Karki of Lagankhel Mental Hospital: “Medicine now has treatment for mental diseases, just like for physical ailments. Problems of the mind also need medical care and treatment and there is nothing wrong in that. Instilling this understanding will help address stigma for patients.”

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However, Karki cautions that medical interventions alone sometimes do not suffice because the triggers may be a combination of biological, psychological and social factors. For example, there was a surge in mental disorders in Nepali society during the conflict and after the earthquake and Blockade. Out-migration and family separation pushes people into another class of mental illness, like neuroses, such as depression and anxieties in which, unlike psychosis, the patients preserve a sense of reality.

Following hospital treatment it is up to family to provide psychological support for patients, to think positively and maintain a healthy lifestyle. They must protect patients from extreme stress due to social factors, such as unemployment or financial trouble.

Muna Tamang shows extraordinary determination this week as she sits beside the hospital bed of her 24-year-old daughter who is suffering from psychosis. “As long as she can live and heal, I have decided that we will do anything for her treatment, even if we have to take loans,” Tamang told us.

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Nepal’s mental health facilities are mostly based in cities, but even here there aren’t enough trained specialists to deal with what is a national mental health epidemic. Up to one-third of Nepal’s population suffers from some form of mental illness, according to one study. (See chart)

One group, The Transcultural Psychosocial Organistaiton (TPO) is working to remedy the urban-rural mental health gap, by training doctors and health workers at the local level with Female Community Health Workers.

“We do not just want to make these services available, but to also ensure people reach out to them, and refer patients to seek help in facilities,” says Kamal Gautam at the TPO.

Such efforts have helped remove stigma, and empowered patients and families to receive treatment and care. But Nepal still has a long way to go. With greater state investment, access to mental health services and proper therapy, family members can be even more involved in helping patients and reducing their stigma.

Some names have been changed.

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