Faith and Mental Health

There is research based evidence that religion and spirituality help prevent many physical and mental illnesses, decreasing both symptom severity and relapse rate, enhancing recovery, as well as rendering distress and disability easier to endure. Religious and spiritual factors can significantly affect the presentation of mental disorders and its knowledge is of utmost importance for proper diagnosis and treatment.

In a country like India it is fair to say that the vast majority of the population believes in one or other religion with varying influences of local and diverse culture on the same. When it comes to the treatment of common mental illnesses in India, unlike West, faith healers and religion is the first port of call.

There is truer for rural population which comprises majority of the population. When a patient comes to see a psychiatrist, it is likely that the family has already exhausted a number of options including faith healers. Although there is no proper research data from India, from clinical practice, it is fair to say that religion and faith healers play a big role in the recovery of many common mental health conditions.

Conditions like dissociation, conversion, day to day stress, anxiety problems are managed by visiting holy sites, gurus and faith healers. They act as counsellors and religious places give a platform to vent emotions. Many people also turn back to religion in difficult situations to find solace. Some times this is the only hope in one’s life. There is evidence that suicide rates are lower in populations where religion prohibits suicide, and thus faith or religion becomes a protective factor.

Lately concept of spirituality has been introduced into psychiatry and is considered more inclusive and affecting everybody. Some consider the concept of spirituality better than religion, claiming that unlike religion it is not divisive and can be adopted by anyone.

Spirituality is also considered more secular, and applicable to the whole field of mental health care. There are advocacy groups who call for routine assessment of spiritual health in all mental health patients. According to the World Health Organisation, ‘Patients and physicians have begun to realise the value of elements such as faith, hope and compassion in the healing processes. The spiritual dimension includes these factors and goes beyond religious affiliation. According to the WHO, it may be categorised under four headings: transcendence, personal relationships, codes to live by, and specific beliefs.

In western psychiatry, there is emphasis on spiritual training and providing adequate resources and manpower. Chaplains, Imams and other religious leaders are regularly employed by the psychiatric and general hospitals for providing ongoing support to patients in need. Sometimes religious beliefs make people not to take certain kind of treatment and having a religious person to counsel the patient at that time proves a great help.

On the other hand, when many people do find religion and its practices helpful in recovering from common mental health conditions, there are times when it acts adversely because of the negligence and uncontrolled mushrooming of people acting as faith healers.

Some faith healers advocate stopping medication prescribed by doctors which can be risky and life threatening in conditions like epilepsy and mood disorders where medication forms the first line of treatment. Sometimes people with learning disabilities, psychosis and other conditions are treated in a very inhuman way and tortured based on ill formed beliefs around religion. People are sometimes chained at some places run on the name of religion and faith.  There have also been incidents of sexual and physical abuse by self-styled religious leaders.

India has unlimited resources when it comes to religion, spirituality and faith healers but there needs for some training and sensitisation so that people do not intervene beyond their capacity and untoward incidents are prevented. Psychiatric departments need to organise regular workshops for local faith healers for coordinated work so that people who need medical intervention are promptly referred.

There is also need to keep check on rogue people who tend to exploit people on the name of religion and more so mental health patients who may be more vulnerable when unwell. Engaging faith and spirituality will also enhance the experience of patients and help build trust in their treating psychiatrists. 

 http://healthanalyticsindia.com/healthanalytic/faith-and-mental-health.html

Hepatitis C and preventive measures

Kashmir valley is witnessing another disaster in the form of Hepatitis C epidemic. In some villages in Kokernag area the number of cases is around 40% of the total population. In spite of media pressure and demand from local population, authorities are still contemplating curbing the further spread of this infection. Similar scenario exists in other districts of the valley like Shopian, Kupwara, Srinagar and other areas of district Anantnag.

Hepatitis C is not transmitted by routine personal contact and there needs to be an actual transfer of the virus via blood, blood products and body fluids, from one person to another. From the sociodemographic profile of the rural population, one can easily exclude intravenous drug abuse or sexual contact as the cause of the current epidemic in majority of cases. The unsafe use of syringes and instruments by health professionals, dentists, chemists and quacks does explain this explosive nature of the problem. The situation is made worse by the lack of training and accountability, unsafe sterilisation procedures or no sterilisation at all.  The reuse of disposable syringes is quite common and people are not used to questioning the unsafe practice. Stitching of common injuries at health centers is another common mode of infection. The practice of circumcision in our community puts children at high risk if proper precautions are not used. Unsafe dental practices and mushrooming of dental quacks is another worrying reason.

Use of injections is a common practice more so in villages. Even for minor ailments, people prefer to get medication by injection than by oral route. There is also a practice of using intravenous fluids in villages for no apparent reason. A large number of injections are superfluous and either due to the public, the patients, and erroneous beliefs in the superiority of injections compared to pills, or due to unscrupulous providers /quacks, who like to inject people because of greed for extra money.

People should take extra precautions when seeking help for any medical condition. When your doctor prescribes an injection, ask if you can get along without any medicine, or if an oral alternative is available. Many conditions, such as colds, flu, dry cough, and diarrhoea are better treated without injected medicines. Most drugs and other substances can be taken orally, and should be injected only in rare situations like if someone is unconscious, or vomits so much that oral medication will not stay down. Vitamins, glucose, paracetamol and other drugs to reduce temperature, most pain-killers, treatments to stop diarrhoea or vomiting, medicines to treat asthma, antibiotics (with a few exceptions, such as penicillin) should be taken orally.

Only new and disposable syringes and needles taken from a sealed package should be used. Syringes should not be kept at home for reuse even on the same patient because it is potential source of infection.  If for any reason syringe or needle has to be reused, ask if it has been autoclaved or boiled.

Single dose vial should be used as much as possible, which is a small bottle with medicine for one injection only, so that there is no need to reuse the medication on same or other patient. Multi-dose vials, with medicine for many injections, are often used by dentists and anaesthetists when giving local anaesthesia like during removal of a tooth. This can become a source of infection if both the needle and syringe is not changed between the patients.

If no single dose vial is available, see that your doctor takes medicine from a new multi-dose vial opened in front of you. This may not always be possible and many doses are taken out from same bottle. Some people have the bad habit to only change the needle (and not the whole syringe) between two injections for a same patient, (and only change the whole syringe in between patients), which contaminates the vials because of the reflux mechanism, and you are placed at risk of getting contaminated with the virus (HIV, Hepatitis B & C) or bacteria of the patients before you, including drug resistant bacteria.

Recent investigations in the USA on nosocomial epidemics of Hepatitis C showed that badly trained, unscrupulous care givers only changed the needle and not the whole syringe to re-inject a same patient from multiple dose drug vials. In the process of injection, when the needle is pulled out, microscopic quantities of blood (not visible with the naked eye), gets back up into the syringe. Thus when only the needle is changed and syringe is reused, multi-dose vial gets contaminated with the blood from the syringe possibly containing the infection. Then, when the vial is used for a new patient, even if a totally new sterile syringe is used, the new patient is at risk of getting infected with the virus/bacteria of the patient or patients who came before him for treatment (and many microorganisms remain viable for days in microscopic drop of blood). In 1996, even in North America, more than half of anaesthesiologists had those bad 'dirty' practices. Many health care givers are not conscious of the danger of this practice. So both needle and syringe should be changed with every withdrawal of medicine from the vial.

Another option is to take injections from pre-filled disposable syringes– which are disposable syringes combined with single-dose vials, or single dose cartridges.  ‘Smart syringes' which include a manufacturing system which makes them definitively non-reusable, but they are unlikely available due to cost issues.

Many people give injections – not only doctors and nurses, but also pharmacists, traditional healers, family, and friends. No general statements can be made about who gives safe injections. If a trained provider respects your requests, uses a new syringe and needle, and takes medicine from a single-dose vial, you are probably safer with the trained provider. But if the trained provider will not do so, you may be safer with an untrained provider who will listen to you.

Finally health care providers need training around infection control and sterilisation so that this dangerous epidemic is put to a halt before it is too late. Every new case is a potential source and the only way to break the cycle of further transmission is to practice honestly and safely. It is your right to demand safe health care and question where ever you are in doubt. A five rupee syringe can save you money, can save your health and ultimately your life. 

http://www.greaterkashmir.com/news/opinion/hepatitis-c-and-preventive-measures/186152.html

The Collective Conscience

Why do the lives of some seem cheaper than others?
Dr Mudasir Firdosi

Thirteen years ago a drunk driver drove his car on a footpath crushing many poor souls, sleeping rough. One was killed and many injured. With more than a decade of lengthy court proceedings he was finally found guilty and awarded a few years prison sentence. While many were betting on the verdict, some were praying to their gods and goddesses for his alleged innocence and favourable verdict, no one remembered the victims of the crash.

India, where more than fifty percent population lives in poverty, one would have thought that majority will identify with the victims but the situation seems quite opposite. The social media is full of fury from elite to middle class to anyone using Facebook or Twitter, condoning the drunken driving incident. Some pleading that it was not his fault and people should not have slept on the footpath. Some stooped further declaring all those homeless worse than dogs. Most of the TV channels or media houses even forgot to mention about the plight of poor victims and ironically no one reported that a drunk driver was found guilty and hence appropriately sentenced. Some justify the action by quoting other elites who have killed people in similar manner and have never been questioned or arrested. Some talk about 2002 Gujrat riots and how even the convicted murderers got out on bail.  Some are worried about 200 crore loss to Bollywood and many are praising him as a philanthropist and saviour of poor, trying to influence the judicial process. Sadly one man tried to end his life in front of the court from almost same very social class as the actual victims in protest against the verdict. 

This begs a serious question, what has happened to the nation’s conscience. How do you call the country as largest democracy on one hand but want to impose princely rules on the other hand for select few. Why do the lives of some seem cheaper than others? Where did it get wrong?  Does it have to do anything with the prevailing post-colonial mentality and VIP culture? How much is the media responsible for shifting public perception and make anyone a villain or hero. Does the public sentiment have any bearing on courts verdict? Only few years back while deciding the case of Afzal Guru, even the Supreme Court of India mentioned in the judgement about ‘the collective conscience of nation’ and keeping it at centre of decision making. By that logic the court seems to have got it completely wrong after all it does not matter whether the evidence is there or not when it comes to what nation wants.

Surprisingly the higher court suspended the five year sentence till further hearing quite unlike the numerous cases where common people have to wait for months even to get a bail for petty crimes. Does that mean the judicial process is influenced by power, money and public opinion?

What else can be the reason knowing that someone has done a crime by taking an innocent life but people still feel sympathetic towards the perpetrator. Whenever, someone is considered superior for any reason, it becomes a breeding ground for injustice and lawlessness. People are even indifferent to some draconian laws framed by the state which provides impunity to ‘killers and rapists’. The deep rooted issues with inequality, racism, caste, communalism and elitism have been normalised and even the victims fail to see the injustice. The rampant corruption seems to have crept beyond the material world having been normalised at religious, moral and ethical level. 

The psychological state of ‘learned helplessness’, which results from prolonged use of coercive methods, either physical or mental, makes people to lose their free thinking.  When people feel that they have no control over their situation they may also begin to behave in a helpless manner. This inaction can lead people to overlook opportunities for relief or change. This phenomenon has taken over the majority. Even though apparently free to choose and act there seems to be a need to worship VVIPs and people in power and take their actions for granted even if it costs the life of common man. The mere acceptance of differential treatment depending on fame and power speaks volumes about the slave mentality and ignorance about basic human rights.

If celebrity goes to prison or is let go, probably does not matter much. But it is worrying when common man identifies with the offender and ignores the sentiments and rights of fellow citizens. Last but not the least; anyone can be a victim and it is never late to let the justice prevail.

http://risingkashmir.in/news/why-do-the-lives-of-some-seem-cheaper-than-others/