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Jakarta Post

Nurturing hope for mental health recovery

The recent World Mental Health Day on Oct

Adhitya S Ramadianto (The Jakarta Post)
Jakarta
Wed, November 22, 2017

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Nurturing hope for mental health recovery

T

he recent World Mental Health Day on Oct. 10 was an appropriate reminder that eradicating stigma is still an unfinished task in improving the lives of people with mental illness.

In recent years we have seen a welcome improvement in mental-health awareness. Driven by the high prevalence of mental-health issues worldwide and its vast impact on public health, stakeholders are organizing to eliminate the stigma surrounding mental-health services so that people can access the help they need. Social campaigns have been launched in many parts of the world, and public figures openly talk about their mental-health struggles as a reminder that it can happen to anyone.

However, one year into my psychiatric residency training, I realize we still have much work to do. Combating stigma so people can reach out for help is one thing, but educating the public about mental health is quite another story.

One of the most persistent stigmas is that people struggling with mental illnesses are “lost causes” who will not improve much despite the best efforts. This stigma can be partly traced to the chronic and deteriorating course of mental illness, especially serious mental illnesses such as schizophrenia or bipolar disorder. Furthermore, the stigma can rear its ugly head in many ways.

Most of us are familiar with “social stigma,” where community members, including family and friends, retain negative stereotypes about people with mental illness and act accordingly. When family members view a patient as “permanently defective”, they think the mental condition will only worsen, so they make little, if any, effort in supporting the patient. Reports of people with mental illnesses being shackled and denied basic needs are not uncommon here.

When institutionalized in public policy, stigma perpetuates social exclusion and discrimination against people with mental-health problems. For example, mental-health care is generally underfunded compared to other types of health care, and rehabilitation services to help patients get back on their feet are scarce. Also, people with a history of mental illness are still discriminated against when seeking employment.

Less discussed but just as dangerous is self-stigma. As people struggling with mental illness become aware of how they are considered “lost causes,” they may unconsciously absorb those stereotypes, eventually influencing their thoughts and behavior.

They lose motivation for treatment and withdraw to avoid social rejection. Patients with severe self-stigma show lower self-esteem, hope and self-efficacy. It also affects the outcome of their illness: self-stigma is associated with more severe symptoms, poor treatment adherence and a lower quality of life.

My colleagues and I have witnessed how these stigmas painfully play out in the care of our patients. At the start of treatment, we have to spend considerable effort educating and convincing our patients’ families that, given adequate social support, most people living with mental illness can and do get better with treatment. We strive to instill hope in our patients and their families.

In the past, psychiatric treatment was focused on remission or complete elimination of symptoms. After all, most people still think that hallucinations, delusions, or extreme mood swings are all there is to mental illness. However, achieving remission does not necessarily mean the patient is doing well in life.

For example, people living with schizophrenia often suffer cognitive problems and a social-skills deficit, even after the hallucinations and delusions have subsided. They face difficulties navigating social situations or performing their duties, leading to limited social participation.

Therefore, treatment has now progressed toward the recovery paradigm. The goal in recovery is not only to achieve remission, but also to help patients regain as much of their functions in life as possible.

To do so, medication alone is not enough; psychotherapy and other forms of rehabilitation are indispensable. Some patients may need help to build resilience under stress while others may require training in social or vocational skills. The journey is long and requires great effort, but recovery is attainable.

Hope is an absolute necessity for patients and caregivers in that journey. It is a source of strength and motivation needed in every step of treatment. A greater sense of hope is linked to symptom reduction, improved social functioning, better subjective perception of recovery and higher quality of life. Hope also protects patients from the effects of everyday stress.

On the other hand, stigma is associated with hopelessness. I have seen firsthand how hopelessness impedes the journey toward recovery and exacerbates existing problems.

Something as simple as coming for the next appointment could be perceived as a burden, so we can guess how unmotivated patients and their families might be in adhering to long-term therapy and rehabilitation. It results in less-than-effective treatment, which causes symptoms to persist for too long. In turn, the persistence of symptoms further dampens the patient’s hopes, creating a vicious circle from which it is harder to escape.

Eradicating the stigma against people living with mental illness goes hand-in-hand with nurturing hope for everyone on their journey to recovery. People with mental illness have as much chance as any other person to live meaningful lives.

Failing to support them would be a grave mistake and a waste of precious opportunities.
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The writer is a doctor living in Jakarta

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