The Tribune, Chandigarh, India

	The reality of mental disorders By Dr N.N. Wig and Dr R. Srinivasa Murthy IT is two years since the Erwady tragedy shook the conscience of the country owing to the neglect of mentally ill persons in India. On August 7, 2001, 27 mentally ill persons were charred to death while chained to pillars near a religious shrine in Ramnad district of Tamil Nadu. In view of this, the Supreme Court has been considering the various issues of human rights arising from the tragedy. At the state level in Tamil Nadu as well as at the local district level a number of changes have occurred with hope for better days ahead for the mentally ill. In a way, the spark that killed 27 persons has turned out to be a “spark for change”. The central issue is: Why do people not give mental health the importance it deserves? Why is the reality of the lives of the mentally ill so far removed from the scientific understanding that we have about mental disorders? There are five reasons for society to give importance to mental disorders. Firstly, mental disorders are very common and occur in individuals of all sections of society. It is estimated by the WHO that one in four will experience a mental disorder during their lifetime, and at any time at least one in 10 are suffering from a mental disorder. There are differences in the rates and pattern of mental disorders among men and women. For example, men have more of alcohol abuse and drug dependence while women suffer more from anxiety and depression. There are similar differences among the rural and urban populations and among those going through stressful life experiences such as after disasters. A general observation is that it is a combination of stress, lack of social support and personal coping skills that results in mental disorders. It is important to remember that the causes for mental disorders are biological, psychological and social in origin. It is not any one of them alone that results in mental disorders, but a combination of the three. Secondly, mental health has become a matter of great concern. Currently, disability is used as an important measure of the public health burden of different conditions. Disability caused by the mental disorders is indeed very high. In the 15-44 years age group, eight of the top 20 health conditions causing disability are neuro-psychiatric disorders. It is estimated that by the year 2020, depression will become the biggest global burden of disease, next only to heart disease. On the whole, more than one-third of disability in the community is due to mental disorder. Thus, treating and preventing disability due to mental disorders, is not only good from the human rights point of view but also in terms of the cost to society. Thirdly, effective treatments are now available to treat the majority of the mental disorders. The treatments can be medicines, psychological support or rehabilitation and a combination of the three at various stages of illness. For a better outcome, it is important that the treatment in serious mental disorders is started as early as possible. Further, the care in the community with the family support gives much better results compared to a long stay in institutions like mental hospitals. Family and community can play a very important role in the care of the mentally ill by their acceptance of mental illness without unduly discriminating against the patient and stigmatising the patient. As far as possible, a patient with mental illness should be involved in social and family life. It helps in the recovery and early return to normalcy. In simple terms, the present-day approach to psychiatric care emphasises a spectrum of services in the community rather than only care in costly big mental hospitals. Fourthly, the care of the mentally ill is now possible to be delivered by a number of measures. The approach of thinking of self-care, informal care, care by general medical personnel, treatment in general hospital psychiatry units and in community care facilities is not only good for the patients but also less expensive and easier to implement as compared to the care in only specialised institutions. Additionally, this also encourages full use of community resources. This is especially important in India, as mental health specialists and specialised facilities are still relatively less available in the country and are not easily accessible to the rural population. Fifthly, the mentally ill continue to experience stigma and discrimination by the community. The discrimination occurs due to the ignorance, fear of the mentally ill and due to long-held beliefs of supernatural causation. As a result, especially in the urban areas, families with a mentally ill person experience serious difficulties in their social life. It is very important to educate the community that as far as possible, a mentally ill person should have the same human rights as other citizens of the country. In our opinion, the foremost human right of a mentally ill is the right to have access to proper medical treatment. Dr Wig is the Emeritus Professor of Psychiatry at the PGI, Chandigarh, and Dr Murthy is Professor of Psychiatry, National Institute of Mental Health and Neuro-Sciences, Bangalore.
	White cane: an eye for the sightless By Prem Singh Bhutte SHE is wearing dark glasses, but she is not a fashionable girl. Far from it, she has an ordinary cane in her hand, and with it she is finding her way. The cane is her eye. But this is not a very efficient eye. A far more efficient eye is available for the blind, but, unfortunately, very few know about it. They are not much interested in it, for their own world is too full of light to care for those who live in a world of darkness. But there are people who do care. They urge the people to observe White Cane Safety Day which falls today. What is this white cane, and White Cane Safety Day? For centuries, the cane has been used merely as a tool for travel and it was not until the twentieth century that it came to be promoted for use by the blind as a symbol to alert others to the fact that an individual was blind. One of the very first persons to modify the ordinary cane specially for the blind was James Biggs of Briston who designed it in 1921 and called it the white cane. The name stuck. Guilly d’Herbemont took over from there and launched a national white stick movement for blind people in France in 1931. The cane’s use has promoted courtesy and provided an opportunity for mobility to the blind on our streets and highways. With proper training, people using the white cane can enjoy greater mobility and safety by determining the location of curbs, steps, uneven pavements, and other physical obstacles in their path. The white cane has given them the freedom to travel independently to their schools and workplaces and to participate more fully in the life of their communities. It reminds us that the only barriers against the people with disabilities are discriminatory attitudes and practices that our society has too often placed in their way. Unfortunately, we in India show little courtesy to the blind, forgetting that anyone of us might find himself in such an unfortunate situation. The writer is the founder-Chairman of the Visually Challenged Persons’ Organisation, Chandigarh.
	Ayurveda & you Personalise your diet plan By Dr R. Vatsyayan EVERY medical system, whether ayurveda, allopathy or homoeopathy, requires the additional support of proper diet to be effective. As conducive food can enhance the effect of medicines, inharmonious diet can equally spoil, neutralise or limit the effect of any type of treatment. Ancient ayurvedic texts while discussing various diseases have elaborately counted dietary factors responsible for their genesis and have given extraordinary weightage to ‘pathya’ which includes the suitable food plan and the lifestyle to be followed normally and during and after the treatment. Though ayurveda treats every person according to his “prakriti” and prescribes a diet plan favourable to the inherent nature of a patient, every single person is considered a separate entity and needs further fine-tuning relating to his dietary regime. Wrong diet is one of the main causative factors of disease and in many cases it is again the suitable diet which can be an effective treatment in itself. According to a famous ayurvedic dictum, there are two types of persons who do not require any medicine. The first one is the person who eats right . Due to the disciplined approach towards diet, he will stay healthy and need no medicine. In the second category, one with indiscreet indulgence in wrong food will always remain ill and thus is considered out of the scope of medicine or any other treatment. Ayurveda views that the taste, energy and the post-digestive effect of every food item alter the three biological humors in its own way. Instead of giving stress to the specific nutritional requirements and the mineral, vitamin and chemical contents of food, its bigger concern is that the food we take should be in harmony with our nature. As all types of eatables either normalise, diminish or aggravate the “vata”, “pitta” and “kapha” in the body, by carefully understanding the personalised effect of a particular food item and choosing the suitable diet plan, a person can keep himself healthy and fit. Food items, by virtue of their heavy, light, cold, hot and dry or unctuous properties, have different effects on different persons. For example, tomato is an essential part of most of our dishes, but it causes inflammation of the mouth to many persons. Apple, though a highly nutritious fruit, is also known to cause constipation to some individuals. We usually notice some persons saying that any pickle or sour and citrus eatable gives them sore throat. Similarly, some people enjoy a cup of coffee at night whereas it causes insomnia to others. This is the practical interpretation of the ayurvedic concept of “ahitakari ahara” or the unsuitability of a specific food item to a person. Diet should also be adjusted according to the climate, seasonal variations and different stages of life. Besides the right preparation, right combinations and right amount of food, some other equally important factors of a personalised diet plan include the right frequency of meals and the right times and places for eating. Above all, it is the right emotional or mental state of a person which is essential to achieve the benefits of diet. Bad moods while eating can always negate the benefits of any nutritious food. Proper diet is the most important factor for the maintenance of life. A person desirous of being healthy should always try to analyse and understand his suitability to various types of food. Always remember that it is the suitability and not the variety or richness of the food which determines our quality of life. The writer is an ayurvedic consultant based at Ludhiana.
	Life Matterz THERE is a growing desire among the people of all walks of life to keep the doctor away. That is why an increasing number of health ensusiasts can be seen walking in the morning and the evening. Exercise, however, is not the only way to make this possible. what and when you eat also plays a major role. For all this, you need adequate information from dependable sources. Life Matterz, a newly launched magazine from Delhi, is one such source. It is a rich addition to the reading material available to the health-conscious people. Life Matterz seems to be a serious effort aimed at answering questions like "...how do I prevent ill health?" and "...how do I maintain a healthy lifestyle amidst the discordant pressures and pulls?" as its Editor, Renu Malhotra, says. Issues relating to exercise, diet, fruits, vegetables, minerals, etc, have been covered extensively in the first issue of the magazine. The language is simple, easily understandable by a lay reader. Its price — Rs 50 per copy — is also within the reach of anybody interested in keeping himself abreast of the latest on health and fitness matters. One hopes the magazine will continue to improve its quality from all angles.