Mental Health Problems - McGill University · and Mental Health Problems ... Adura’s positions...
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Transcript of Mental Health Problems - McGill University · and Mental Health Problems ... Adura’s positions...
![Page 1: Mental Health Problems - McGill University · and Mental Health Problems ... Adura’s positions •Diagnosis based on a) physical behaviours and b) time of the incident. •Identifies](https://reader035.fdocuments.in/reader035/viewer/2022062317/5c1f343909d3f25d2e8c1d6e/html5/thumbnails/1.jpg)
Mental Health Problems
Community Perceptions
in
SRI LANKA
Dr. Rasitha Perera
Dr. Lushan Hettiarachchi
National Institute of Mental Health
Angoda
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Study Location
• Peraliya North
Tsunami affected – 241 families
• Monroviawatte
Post-Tsunami re-settlement - 450
families
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Research Methodology
• Focus groups
Men, women, youth & children separately
• Participatory Rural Appraisal
Wealth ranking & matrix ranking
• Interviews with families of „mentally
ill‟ people
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Identifying PEOPLE “DIFFERENT” to NORMAL
PEOPLE
Sinhala, Tamil, English and Portuguese
words used
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• Pissu, mole aul , olmada, vikara
- (Sinhala)
• Kolam, kalla, kachal, Paiththiyan
- (Tamil)
• Loose, mental, mongol, upset,
by-force, pissu double
- (English)
• Magngnan - (Portuguese)
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Possible Psychiatric Equivalents of People with
Mental Health Problems
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• Pissu, Olmada, Vikara :
- Mania
- Psychosis
• Mongol, Mandayo :
- Mental retardation
- Learning difficulties
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• Kalla pissu, By-force pissu :
- pretending to have mental
illness for own benefit
• Genu pissa, Kamuka pissa,
Mandana pissa, Manamala pissa :
- people with frustrations
- sexual deviations
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• Chitrapata pissu, Hindi pissu,
Phone pissu, Kudu pissu, Ganja
pissu, Race pissu:
- People with various addictions
• Ugath pissu :
- Pathological studying
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• People with different views, beliefs
and behaviour :
- Delusional states
- Paranoid Personality
- Irrational Behaviour
Pissu denotes inability to think
rationally
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• Oluwa awul, Mole aul: - “Muddled
Mind”
- Stress reactions, Anxiety states,
Mild depressions
• but view of life is rational
• commonly seen in day to day life
NOT MENTAL ILLNESS
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NOT MENTAL ILLNESS
• Trance states and possession states
- Temporary states relieved by
traditional healing practices
• If persistent, acquires status
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Causes of Mental Problems
• Family transmission
• Adverse life experiences
• Natural or man-made disasters
• Socio-economic factors
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• Physical factors
• Addictions
• Supernatural powers and curses
• Excessive studying and inappropriate
dedication to education
• Changing religion
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• Excessive thinking and straining of
brain / mind
• Rabies
• Not able to get „varam‟ from a deity
• Complete cure of „rakthaya‟
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BUT
• Evil-eye / evil-mouth (as-vaha /
kata-vaha) does not cause mental
health problems
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Supernatural Influencesand Mental Health Problems
• Malevolent charms done as
- Acts of revenge
(Huniyam, Kodiwina)
- Attract / bind someone
(Ina beheth,Vashee gurukam, Bandana)
• Return effects on person who did the above
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• Effects of planets & zodiac system
- Rahu, Kehetha, Senasuru,
Chandraya
• Effects of evil spirits
- Kalukumara, Mohini,
Thanikandosa or dead relatives
• Karmic forces
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Characteristics of People
Seen as “Mentally Ill”
(Symptoms)
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• Inappropriate behaviours
- laughing to oneself, wandering,
bad language, violence, muteness
• Poor self-care
- lack of cleanliness, over-dressing
• Poor sleep
• Lack of energy
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• Feeling worthless
• Extreme emotion
- happiness, sadness, irritability
• Lack of concern for self or others
• Interpret actions of community in
adverse manner
• Memory impairment
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• Sexual disinhibition
• Excessive washing
• Grandiosity -
• Bizarre behaviours
- Burning household items
- Damaging property
- Spitting indoors
• Suicidal behaviuor
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Family Responses to People Seen as
“Mentally Ill”
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Responses:
• Isolation within family
• Excluded from family gatherings
• Given adequate care and affection
• Not evicted from the household
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Depends on:
• Importance of person within family
• Relationship before „illness‟
*Aggressive people more likely to be
ill treated
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Community Responses to
People Seen as
“Mentally Ill”
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• General attitudes of community
towards people seen as „mentally
ill‟
- Marriage discouraged unless seen
as fully recovered
- Excluded from employment in
responsible jobs
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Attitudes continued
• Not punished for misdeeds
• Families find community helpful
and caring especially in emergencies
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Community reactions…
• Depend on whether aggressive
or calm (non-violent)
- Hostility to aggressive people
- Sympathy towards non-aggressive
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• Depends on extent of family
support
- Those without support get mocked,
provoked and isolated, stigmatized
as lunatics, excluded from social
gatherings (sometimes with family)
Community reactions…
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Types of Interventionsfor „Illness‟ and other
Similar States
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Approach of communities and families
1. Religious activity is first
consideration
2. Look for options near-by
3. Look for options further afield
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– Identified as not very effective
– Expensive
– Difficult to find reliable „Adura‟
– Requires lot of man power
4. Bali Thovil infrequent now because:
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Types of Interventions Available to
Communities
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• Bali thovil
• Seth shaanthi
- Lime-cutting
- Tying chanted thread
• Religious
- Bodhi pooja
- Pilgrimages
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Adura’s positions
• Diagnosis based on a) physical behaviours and b) time of the incident.
• Identifies specific supernatural influences e.g. riri yaka, mahasona
• Performs rituals - screening for susceptibility
• May/may not accept to treat
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• Ayurvedic medicine
- Isakudichchi
- Vireka
- Kasaya
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• Western (Allopathic) medicine
- Oral
- Injections
- ECT
- Hypnosis
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Choice of Intervention
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1. Religious activity at home/temple
pirith, rituals
2. Read horoscope (Astrologer)
3. Lime-cutting or thread with
turmeric (maturanawa)
Sequence of Choice
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4. Thovil - if possible
5. Private (Allopathic) doctor by
channelling
6. Government hospital
- as last resort
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Both villages similar
• Women had more knowledge and
interest in these issues
• Religious activity and astrology
important
• Cutting lime and tying thread is
routinely carried out.
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• More faith in western than
Ayurvedic interventions
• In spite of knowledge about places
there was marked lack of
knowledge about allopathic
therapies themselves
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Factors Involved in Choice
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• Getting patient cured
• Trust and confidence in place if
intervention
• Popularity of place of intervention
• Advice received from others
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• Expenditure to be incurred and
distance to travel
• Belief that admission to hospital is
required
• Need to show others their concern
for patient
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Perceived Effectives of Interventions
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• Majority believed western medicine
(oral and injections) had best effect
• Ayurvedic treatment received low
priority
• Majority considered exorcist
ceremonies do not have much
effect (on what they see as mental
illness)
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• Bodhi pooja seen as having high
effect
• Lime cutting and thread tying
believed to bring relief
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Implications of Study
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• „Illness‟ and possession states seen
as very different entities
• Depression is not perceived as a
“Mental Illness – Pissu”
• Somatic symptoms were not taken
as symptoms of depression
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• Family / community attitude is
sympathy unless there is violence
• Family and community motivated
by wish to get help
• Various places identified for
interventions for illness
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• Variety of causes recognised but
dealing with illness is seen
pragmatically in terms of place that
provides effective interventions.
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• Why no attention to reversing
causes – i.e. prevention?
• Aggressive behaviour is least
tolerated by community
• Barriers to marriage and stigma
not applicable if ill person recovers
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Thank You!