THE SANITY in IN SANITY
(MENTAL ILLNESS :
A NEW PERSPECTIVE)
(1) DEFINITIONS
Can we define Insanity? For that we will have to define sanity first.
The difference between the two is a thin zigzag
line and we use socially acceptable behaviour as the major criteria to differentiate.
Furthermore if Insanity is defined by sane people,
sanity will have to be defined by insane people
(2) STATISTICS
In the U.K. 20% of general population are mentally ill. About 40% of total hospital admissions
for systemic diseases have mental illness. Other stats are
6% Population mania & Depression
9% Women mania & Depression
9% Population Anxiety & Neurosis
1% Population Schizophrenia & Pyschosis
5% Population above 65 yrs Dementia & Alzheimers disease
20% Population above 80 yrs Dementia & Alzheimers disease
(3) CLASSIFICATION OF MENTAL
ILLNESS
(A) AFFECTIVE (MOOD)DISORDERS
(Mania & Depression)
Extremes in
mood (affect) are inherent in human condition Distinguishing pathological mood alternations from normal changes in feeling
has eluded clinicians for centuries Extreme exaggerations of mood, mania (elation) & depression (sadness) with a marked
tendency to recurrence would be called affective disorders by the modern day psychiatrist
(B) ANXIETY & STRESS DISORDERS [ NEUROSIS ]
Anxiety is a common emotional response to the external viciissitudes of life. Paroxysms of persistent feelings of worry and resultant somatic responses of trembling, sweating, rapid
breathing & sleeplessness would be classified as Neurotic disorders
In conversion
(Dissociation) Disorders i.e. Hysteria, mental disease manifests as physical
illness e.g. gait disturbances pseudoparalysis. Aphonia (loss of voice) pseudoseizures
(fits) or pseudoblindness or pseudo amnesia (loss of memory)
(C) PSYCHOTIC (Delusional) DISORDERS. [SCHIZOPHRENIA]
These are mental states
with illogical thinking, loosening of associations, Inappropriate emotions, paranoid or other delusions & hallucinations
lasting at least 6 months.
(D PERSONALITY DISORDERS
Inappropriate
& socially unacceptable characteristic ways of thought, feeling & behaviour (the so called personality) constitute
this group.
(E) MEMORY
DISORDERS
[DEMENTIAS]
Senile dementia implies
memory loss after 65 yrs the so called Alzheimers disease
(F) MISC DISORDERS
Substance abuse (drugs,
alcohol etc), Behavioural disorders, sleep disorders etc complete the spectrum
(4) PSYCHO GENESIS OF MENTAL STATES
a) A human is born
with certain temperamental traits determined by genes. His adult behaviour, his vulnerability & response to stress, his ability to recuperate and his psychological
interpretation of the past stressful experiences all depend on genes. Different individuals respond differently & store
past events differently in their memory areas of cortex.
b) At birth Freudian Complexes are born. Sigmund Freud put forth his hypothesis of sexual inferiority complexes arising in
childhood
The male child is attached to his mother and is constantly worried that the father maydisapprove
and according to ‘Freud is afraid that the father may punish him by castration and that he may then resemble his sister;
without the penis (The oedipus complex)
The female child is attached to the father and
is worried that the mother has already castrated her penis as a punishment (she believes she, like her brother had a penis)
(The electra complex)
In adult life the sons inferiority to the father
translates as an inferiority to any other man and similarly the adult woman develops an inferiority complex to other women.
As the child grows, the complexes to the same
sex magnify and at a adulthood, it is this inferiority that provides the drive for competition, career, marriage, material
success, etc as the man tries to prove himself superior to the other men around, whom he identifies unconsciously with his
father.
c) Childhood events play a very large role in the psychological
makeup of the individual
Frustrations of not getting what one wants, Communication gaps
with parents, siblings & classmate jealousy, difference of opinions with the Teachers, peer pressures all contribute to
the mind set of the child.
Further traumatic events in childhood years like death of a near one, change of school, physical illness, parental
disharmony, failure in class, & realizations that the economically well off children have all the benefits of a easy life
without any struggle all contribute to ones psyche.
d) Large turnabout events
of life like change from educational institutions to the work place, change from one family to another as in marriage,
marital problems, having offspring, change from economic security of the father to economic insecurity of an independent adulthood,
all are unexpected stressors to the adult human. His reactions to these changes
are largely dependent on the Pavlovian Conditioning of the past by the parents, teachers, society and other influences constituting
his inner circle. He is conditioned to respond in a particular manner as dictated
by the concepts and ideology of his inner circle. These responses need not be
necessarily correct for the situation or acceptable to the individual; but he is forced by his unconcious conditioning to
proceed in the custom dictated manner.
Repressions build up in the mind creating great conflict. The individual pushes these to the back of the mind in an attempt to ignore or forget
the conflict rather than active solving of the conflict. These then manifest
in hostile behavioural patterns in the later stages of life.
e) Stressors at work Place, Social life, personal
& family fronts are of the following types- frustration stressors, performance stressor, physical stressor, Bereavement
Stressor, Threat stress or all cause psychological turbulence.
f) Freud sub divided
the mind into conscious and unconscious mind. The unconcious consisted of ego, i.e. what one thinks he is & superego ie what one thinks he should be. Conflicts in ego & superego create all the turmoil
The Ego
& superego are defined by ones past experiences and psychological interpretation of these.
At every moment there is a clash of ego and superego. For e.g. a man might feel he is capable of being the chief manager but he is actually
just a salesman. There is now a conflict.
Conflicts are either pushed away to the back
of the mind (resulting in repressions) or psychodefences are used to camoflague them.
These can be rationalization, intellectualizing, philosophising, escapism, etc.
These further compound the problem as whenever the psychodefence is broken the conflict come back with greater intensity
g)
Biological Factors
Neurotransmitters & Chemicals like noradrenaline, serotonin & dopamine excesses or deficiencies in the brain have been blamed in depression and mania respectively. Increased dopamine
has been blamed for schizophrenic episodes
(5) REANALYSIS OF MENTAL ILLNESS
Let us analyse the
different spectrum of the so called mental illness from a different perspective altogether
A) NEUROSIS (ANXIETY)
Worry and Anxiety
Responses to stress are usual first line defences to stressors or events perceived as threatening. Adrenaline is released to prepare for a flight or fight response.
These cause trembling, sweating, palpitation, hyperbreathing etc, since the body is actually preparing to combat the stressful
event.Unconcious memory of the past anxiety provoking events may cause a general sense of free floating ever present anxiety.
So are we justified in labelling these as unwanted?
B) MANIC DEPRESSIVE (AFFECTIVE) DISORDERS
Depression & mood Dips are responses to frustration
and unfulfilled desires let downs to
unusually high expectations or super ego - ego conflicts.
The mind may react by extreme sadness and total
withdrawal which may serve to decrease input and stimuli to the already tired
mind ? sleeplessness due to subconscious efforts in problem solving, feeling of hopelessness and worthlessness since the psychodefences
generated to rationalize or intellectualize ones inadequacies are now broken and this may continue till the time the mind
comes to terms with ones actual capabilities and worth or worthlessness. Can we debate on the utility of the bodys Inherent
defence mechanisms?
Or should we blame the rise/fall in neurotransmitter chemicals in the brain for the mental states without knowing with certainty whether
these are the cause or the effect of the mental states.
C) PSYCHOTIC DISORDERS[SCHIZOPHRENIA]
Talking of schizophrenia, patients are usually
intellectuals with a high degree of intelligence
Unresolved psychological conflicts reach a point
where they can be tolerated no more and all logical thought associations break probably
as an attempt to release the mind from intellectual burdens of reasoning. Hence
the inappropriate emotional responses can be easily understood for e.g. if a patient laughs at the death of a dear one, it
is because he can no longer bear the sadness of the bereavement and hence, his
mind as a defence mechanism has broken all logical connection between death & sadness.
He may hallucinate and hear voices telling him
whats he want to hear or what he is afraid of confronting and similarly see visions
which satisfy his desires or expectations.
These are mind generated real time fantasies
which temporarily satisfy the patients ego. for e.g. One may believe he is the
prime minister at last and may hear phone calls from his cabinet ministers.
The paranoid delusions (suspiciousness) may take
the form of suspicions of sexual infidelity or irrational beliefs of persecution etc. For e.g. one may believe that he is
being followed by the Mafia, or that his wife is having an extramarital relationship with his boss.
These delusions may be created by the brain as
a defensive mechanism to stabilize the turbulence in the mind. There are already
existing doubts in the patients mind which tear him apart by creating a conflict between doubt and fact. The brain creates the delusions to endorse a final evidence, thus allowing the patients mind to conclude
in one direction, the direction of the doubt. The delusions therefore serve the
purpose of setting the conflict in the patients mind.
(D) PERSONALITY DISORDERS
to define these, we have to first define normal
personality. Inappropriate and socially unacceptable behaviour may be very well justified by the individual displaying the
disorder.
(E) SENILE DEMENTIA
too, causing loss of memory in the elderly (or
Alzheimers disease) may be a process in which memory loss could be a necessary component of ageing, as a defence to unwanted
anxieties to the individual nearing the end of his life. This can be compared
to the somatic diseases of cataract, Osteoarthritis etc which compulsorily reduce the exertional activities of the elderly,
to comply with the reduced cardiac function, which is concomittantly present
(6) CONCLUSIONS
So Does Insanity signify the cracking of the
human mind due to unresolved psychological conflicts OR Is it an unconscious compensatory mechanism of the human mind to deal
effectively with repressions, unfulfilled desires and unacceptable memories? The result of these causing temporary stabilization
of the superego ego imbalances. This is probably
necessary to avoid catastrophes in life like suicide, homicide and destructive behaviour
So should we look down upon these mental states
as mental disease or should we consider them to be compensated states of the troubled human mind.
We need to understand that the various manifestations
of the so called mental illnesses are nothing but enactions and verbalizations of countless unfulfilled desires and expectations
that characterize the species called human beings. As Lang has put it, “Insanity is the reaction of a sane mind to an insane society”
