Stress related mental disorders

H. S. S. Nissanka (MA, Ph.D)

This is a subject which is of tremendous universal importance. Millions of people throughout the world do suffer from a psycho-somatic illness known as ‘Stress’ of which there is no sufficient public awareness particularly in Sri Lanka. Stress can be likened to be a destructive flood taking place in the dead of night while people are fast asleep.

Generally the word ‘Stress’ means tiredness or strain - a state in which one is unable to bear up external or internal pressures of normal life. Shocking experiences such as death of dear ones, loss of property or positions, family problems and too many demands, may cause stress and strain, which in turn, may make a person mentally ill.

Continual stress and strain may lead to psychological disorders, such as depression, hysteria, insomnia (no sleep) or amnesia (loss of memory) and other mental illnesses, including psychotic and neurotic disorders. Stress and strain can cause physical illnesses such as cancer, brain tumours and ulcerous growths.

Sociologically stress can cause family problems such as strained relations between husband and wife, and break up of families, which in turn can lead to even suicide or homicide as evident even from media reports and sociological studies conducted by some universities.

If adequate measures are not taken to curtail stress and strain at individual level, even highly developed countries such as Japan, Germany or the USA would not be able to maintain their dominant positions in the world. It is not an exaggeration to say that stress can cause crises in modern civilizations.

If you make a visit to a mental patient’s ward in a general hospital such as Kandy or Peradeniya or to the mental hospital at Angoda, you will see hundreds of mental patients with stress related illnesses.

There are some mental patients who get treatment at State expense for more than twenty years. This is an undeniable fact. The long queues that you may find at consultation centres in Katukelle in Kandy will make you wonder whether the two consultant psychiatrists can treat all such patients in two hours.

In one such a queue, I saw patients from Ampara and from the village Mipilimana in Nuwara Eliya District. Mental patients come to Kandy from distant places. It is so in places like Colombo and Galle too. The small number of psychiatric consultants in the country, simply cannot cope with the demand.

A social stigma

Some people are afraid to be seen at psychiatric consultation centres because of a social stigma-that so and so is taking ‘Pissu beheth (medicine for madness). I m deeply moved by the plight of unmarried women.

Our society is generally cruel to them. Even after marriage, if the groom’s party gets to know that the bride has had a mental illness, the marriage is doomed to be short lived. For example, consider the following case.

Having seen a young beautiful girl, the mother of a young man moved heaven and earth and got the marriage through. The couple went on honeymoon. The groom saw his bride taking some pills. On inquiry, it was found that the bride was taking psychiatric drugs. They came for the home-coming party. Son told his mother about the pills.

The marriage lasted only eight days. The bride was dropped at the doors step or her parents with shower of abuse.

This case was all the more pathetic because the groom was a medical doctors: and the divorce was through within eight months of the marriage.

Stress at universities

Quite a number of university boys and girls get nervous breakdowns, particularly before and during the examination times. They complain of mind going blank or of insomnia or getting high fever or continual purging.

The cases of depression are on the increase in our campuses. One final year medical student down with depression admitted that he was contemplating committing suicide by keeping his neck on the Kandy - Matale railway line.

Suicide problem

In Sri Lanka suicide has taken more lives than the war with the LTTE during the last twenty five years. This is very well explained by Karunatissa Atukorale of Sociology Department Peradeniya University in his book ‘Suicide Problem and Prevention’.

In this sociological study, the author has shown that annually the suicide rate in Sri Lanka, is on the increase. All these facts indicate the degree of stress and strain in our country.

Teachers

Such stress related mental illness are rampant even at Maha Vidyalayas. Among the teacher population stress is on the increase. They are over burden with work loads.

Some lady teachers have to get up b y 3.00 a.m., cook meals for breakfast and lunch for the family, hurriedly get ready, travel long distance by bus or train, sometimes sleeping while standing: get down and rush to the school before the red line is drawn. After five hours of teaching to crowded class, they face the same tedious return trip.

Sometimes, by the time they reach homes, their children have gone to bed. No wonder that most middle aged teachers do suffer from stress related mental illnesses.

Unhappy life

Professionals of various categories do suffer from stress and strain as revealed by Devika Peiris in her M. Phil thesis submitted to the University of Kelaniya. I still remember the faces of the middle aged Rotary Club members of New Maguru, Tokyo who came to listen to my lecture on ‘The sex problems of the Middle aged Professionals’ given in 1976.

Stress is there everywhere. I am yet to see even a Cabinet Minister in Sri Lanka or India who is free from stress and strain. More and struggles for power, more and more he will get into stressful and unhappy life.

As the American political scientist Hans J. Morgenthau says, politics is struggle for power - to gain power and remains in power.

Mono dimensional therapies

As chemical medication was found to be not very much effective in bringing complete cure, some have turned to meditation (Bhavana) as an alternative way of therapy for mental disorders. As shows by Christopher Mclean, there are three schools of Buddhist forms of meditation - Tibetan, Zen and early Buddhists.

Some researchers have experimented with Hindu traditions such as Yogasanas. Several institutions and Universities in the East and West are now conducting Buddhist therapeutical courses leading to post graduate degrees.

Ten Siaw Ming of Malaysia in his M. Phil thesis - ‘Critical study of Buddhist Psychotherapy’ (this writer’s book), has listed as many as fifty institutions in the West and the East which have turn to meditation as a therapy for mental disorders. I would like to recommend ‘Full Catastrophy Living’ by Jon Kabat-Zinn for anyone interested in Buddhist Meditation as an alternative therapy for mental disorders including stress management.

Before the present day waves of interest in meditation, right along with the development of psychiatry, Freudian schools of psychotherapy attempted removal or exposure of the patient’s memories linked to mental illness by means of psychoanalysis.

Behavioural schools of psychotherapy, which was advanced by sociologists, such as Krazner and Ullman, attempted removal of symptoms of mental disorders, as a therapy. Neither of these two methods by itself can cure mental illness completely: because these schools of therapy including psychiatry are mono-dimensional.

Having realized the inadequacy of the above mentioned methods, I have attempted the development of multi-dimensional system which is now known as ‘Buddhist Psychotherapy’.

This system of therapy is called ‘Buddhist Psychotherapy’ because it is based on the Buddha Dhamma - particularly on the Satipatthana Sutta (Doctrine of Mindfulness) and Sabbasava Sutta (Doctrine of Mental Defilements). This method of psychotherapy has received academic recognition in many a land.

Stress related mental disorders

This multi-dimensional psychotherapy aims not only to cure the particular mental illness but also to develop the full personality of the patient by following the features given below. This system is designed to finish the course of therapy within six to twelve one hour sessions. Every session has specific targets to achieve.

Study the medical records of the patient first (if he has had) if the patients’ behaviour is violent or extremely depressed, he should be referred to a psychiatrist first. When his violence or depression is reduced and if he is capable of communication, therapist has to go ahead with the following therapeutical steps.

1. Develop communication with the patient as explained in the book Buddhist Psychotherapy. Certain techniques and principles aimed at developing better understanding between the therapist and the patient have to be followed. Without kindness and care (Karuna) in the heart of therapist, no development of communication between the patient and therapist is possible.

Development of awareness

(II) Get the attention of the patient focused on his body-help the patient to see and know his own body and its movements (Kayanu passana) - allow passive awareness of the body to get developed, guidance to do so should be provided at the therapeutical sessions (each session should be limited to one hour)

III Patients do have pains of the body and pains in the mind but they are hardly aware of them. Get the patient to know his pain by means of scanning the body internally and externally. This concentration on the body pains must be done daily in the morning and evening spending about twenty minutes each time, for a period of one week.

Unconscious

IV. By means of memory regression, get the patient to speak about his past experiences related to the illness. Sometimes even the unconscious of the patient will be exposed along with the memories.

The memories thus exposed will indicate the character type to which the patient belongs. There are four character types prone to mental illness (see Anguttara Nikaya Text - Chatutta Vagga) 1. Raga type = Desire driven 2. Dosa type = Anger driven 3. Moha type = lgnorance = remorseful type 4. Mana type = Conceit = superiority of inferiority conscious type.

Exposure of memories or talking about them will lead to the process of catharsis-a term first used by the Buddha = Ariya Virecana, Catharsis will reduce tension of the patient.

V. Analysis of the patient memories and behaviour traits will reveal the predominant klesha of patient’s life. In Buddhist Psychotherapy, kleshas, mental defilements are recognised as the predominant cause of the mental illness.

Thus, in the process of psychotho analysis the patients are encouraged to see and know the particular klesha as the major cause of his mental illness. This process will lead the patient to develop inward looking awareness which is therapeutical. In any mental disorder such as depression or schizophrenia mental defilements such as remorse or suspicion can be seen easily by the patient.

VI. For the patient to see and know his own mind, he should be placed in peaceful and pleasant atmosphere.

He should be encouraged to visit religious places in keeping with his own faith. For instance, a Buddhist should be encouraged to visit a Buddhist temple, a Hindu to a kovil, a Christian to a church and a Muslim to a mosque. This is aimed at spiritual development at basic level.

Meditation

At religious place or at home, the patient must be guided to practice two forms of meditation 1. Metta Bhavana - Meditation on good wishes to all 2. Meditation on breathing process taking place in the patient - observing and becoming aware of how he breaths in and breaths out.

These two forms of meditation will promote self-discipline by means of developing awareness of what he does or speaks and thinks.

VII. While the patient is on the way to full recovery, efforts must be made to rehabilitate him in the following areas.

(a) Encourage him to build up self-confidence and maintain good appearance.

(b) In family and community set up, treat him as normal person - for instance eat with him and play with him. Encourage him to participate even in intellectual discussions or listening to music or watching a teledrama with family members.

(c) Involve him in economic activity which will give him economic security. Wherever it is possible, find employment or engage him in commercial or agricultural projects.

(d) Encourage him to engage in sports activity such as playing badminton or swimming.

Thus, the rehabilitation of the patient will make him a normal person. Special attention should be paid to discover the talents of the patient and help him to develop his personality along with this talents.

To be continued