THE SANITY in IN SANITY
(MENTAL ILLNESS : A NEW PERSPECTIVE) by Dr.D.A .Rao
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
Furthermore if Insanity is defined by sane people, sanity will have to be defined by insane people
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
mania & Depression
mania & Depression
Anxiety & Neurosis
Schizophrenia & Pyschosis
above 65 yrs Dementia & Alzheimers disease
20% Population above
80 yrs Dementia & Alzheimers disease
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
(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
& socially unacceptable characteristic ways of thought, feeling & behaviour (the so called personality) constitute
(E) MEMORY DISORDERS [DEMENTIAS]
Senile dementia implies memory loss after 65 yrs the so called Alzheimers disease
Substance abuse (drugs, alcohol etc), Behavioural disorders, sleep disorders etc
complete the spectrum
(4) PSYCHO GENESIS OF MENTAL STATES
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.
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.
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
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.
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
(5) REANALYSIS OF MENTAL ILLNESS
Let us analyse the different spectrum of the so called mental illness from a different
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?
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
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.
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.
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.
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
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”.