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Mental Illness: The Sanity in Insanity

THE SANITY in  IN SANITY

(MENTAL ILLNESS : A NEW PERSPECTIVE) by Dr.D.A .Rao

 

(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”.

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