Friday, May 29, 2009

Psychiatry: not just a “short question”!

Twenty years ago when I joined Medical College it was beyond my imagination that patients suffering from mental disorders could be treated. By the time I reached my final year at the college we learnt a few things on mental illnesses but we actually had to prepare for one “short question” for the medicine examination. Many medicos didn’t bother to learn the subject for it really didn’t matter whether one was able to answer the “short question”. Thus when I came out as a doctor I had very little knowledge on mental illnesses and almost no skill to treat people from suffering from it. I had to work in the districts of Bhutan, all alone, managing patients suffering varied conditions from common cold to cancer! However, I didn’t come across many people suffering from mental disorders. The only mental condition I ever treated was hysterical conversion disorder the female students of High School used suffer from. I believed fully on the theory of Sigmund Freud and didn’t think it was really necessary for us to delve into their problems very much, thus the treatment used to be crude and rough!

The violent “psychotics” always scared me and I dared not get closer than ten metres from them. It didn’t occur to me that they required medical help and I thought police was the right people to “take care” of them. Moreover, this type of patients was very rare in the districts though Thimphu had quite a few psychotics roaming the street. They dwelled on the pavements and lived on whatever few compassionate Bhutanese offered them. Barring these, I didn’t ever imagine that people in Bhutan could suffer from conditions like depression and anxiety, and how could anyone suffer from mental stress anyway?

Taking alcohol and smoking marijuana, I thought was not an issue at all. Alcohol is a socially acceptable drink and very few oldies used to smoke marijuana earlier, therefore, these could never be problem as far as I was concerned.

Having worked mostly in the district I didn’t think of any other speciality than Public health for my post graduate studies. I was so engrossed in immunization, mother and child health, water and sanitation, etc., that “psychiatry” was never in my agenda. In 1999 Dr. Chencho Dorji came back from Srilanka qualifying as the first psychiatrist. By 2001 he had conducted training workshops for all the District Medical Officers so that we could roughly diagnose the common mental disorders. This was the first time I was ever exposed to real psychiatry. I, sort of, started liking the subject. When he was looking for someone to send for post graduation in psychiatry, I readily accepted.

Now I am here in Jigme Dorji Wangchuck National referral hospital as the second psychiatrist of the country. I find things quite different today. Daily I see around 7 to 8 patients suffering from different mental problems. There are patients suffering from conditions like anxiety, depression, mood disorder, psychosis, somatization disorders etc. Significant numbers of school children are stressed today. Possibly they have to study many of subjects and there is a tough competition every where. There are youngsters who are unemployed and frustrated, a lot of them hooked to drugs. Many of them abuse alcohol too and they are having considerable psychological problems.

Alcohol, which was considered a social drink, is taking its own toll. Many civil servants have become alcoholics and many are suffering from cirrhosis of liver. The small psychiatric ward in our hospital is already over burdened with alcoholics who require detoxification and management of withdrawal symptoms. Alcohol has become a social scourge now and it requires a strong commitment from Public Health to deal with it.

I found out that the psychotics who used to be handled by the police are in fact more docile than the sane people. They actually needed a lot of care and social support. However, there is always delay in starting treatment for them. They are subjected to various other modalities of treatment from rituals to faith healing before they are brought for psychiatric consultation. Similarly, cases of domestic violence, which used to be ignored in the past, are surfacing now. Many depressed patients seem to somatize their problems and move from one physician to another looking for a cure from the wrong hands. They suffer many years of pain before they reach the right place. Psychiatric disorders still bear a stigma; therefore, many people decide to defer consultation till very late. They even despise the doctors who refer them to a psychiatrist.

Now I realize that psychiatry is not just a ‘short question’ in the medical examination but a very important speciality today. In this ever competitive era more and more people are likely to suffer from psychological stress and the role of psychiatrist will become increasingly crucial.

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