State Mental Health Institute in Kohima.
Ketholeno Neihu
Kohima | December 7
An observation among psychiatrists in Nagaland is that one can develop mental illness because of substance abuse or become addicted because of mental health problems. This intricate and interrelated link, as psychiatrists cites “is a thin barrier that separates them.”
However, in Nagaland the acceptance as having a mental illness and being labeled an addict varies mainly due to social stigma. The former being more stigmatized than the latter.
Dr P Ngully, one of the senior most psychiatrists in Nagaland during an interview with The Morung Express said over the years of his experience since 1990s, had come across number of cases with addiction (alcohol and drugs) even being admitted to the Mental hospital.
Dr Viketoulie Peinyu, another senior psychiatrist in the State supplements the case maintaining that a person who has been abusing for a considerable length of time comes with acute psychotic case with “his addiction and mental illness both at an advanced stage.”
Treating them through the medical module for those persons diagnosed as ‘dependent persons’ with treatment available however did not show much results as Ngully associates addiction with that of physical and psychological addiction.
He says, “Physical addiction come very much in the medical domain whereby when someone who is on the substance is made to stop goes through withdrawal symptoms which are a painful experience and the doctor’s role is very important during detoxification. This medical module for detoxification, however, is only for 10-14 days. But the person goes back home and have relapses which become very frequent.”
One important part of the diagnosis is to take history of a patient to get the mental status examination. Ngully says Nagaland follows the International Certification of Diseases by WHO. “So when you take a detailed history, we probe into any history of substance abuse because that gives us an indirect relation about his stress tolerance or his family background,” he points.
The psychological part needs treatment in rehabilitation centre which is for a longer period. Research has shown that a period of not less than 90 days is required in order to change a behaviour. According to Ngully, it is during this process that the psychological issues can be addressed.
According to Pienyu, the longer a person stays in rehab, lesser the chances of relapse. For dependent people on drugs, there are treatments like Opioids Substitution Therapy (OST). These medical interventions in turn facilitate actions to address their mental health like psychotherapy and counseling.
“Treatment gives you good sleep and improves functional competencies, regain health, improves family relationship, which otherwise many drug users or addicts have sleep issues,” Pienyu says.
Ngully maintains that while dealing with addicts in the rehab, he had observed that most of them had distinct mental health problem and adds, “The initiation of these mental health problems could have started during their developmental stage like broken family or being rejected or neglected which had let them to addiction which are interrelated.”
Pienyu who facilitates treatment in the government setup adds that some common cases he had come across are schizophrenia, bipolar, depression, and anxiety disorders. “Quite often we get a mixed of all these mental health illnesses and all are as common as each other,” he observed.
In the State Mental Health Institute, Pienyu informs psychotherapy and counseling is started after the person becomes more stable. ‘Just as it takes a long time to develop the dependence, treatment process is also long as the treatment is not only about the addiction but psycho-social issues,’ he maintains.
One common observation Pienyu remarks is, initially a lot of people to a great extend have the issues at home but since the problem is not so grave or pressing, they do not come seeking for help. They will come to the hospital only when the problem is gone too advanced.
Indirectly, a person who has been abusing for the prolonged period could be contributing to the mental health problem of the other person in the family or circle. In this case, it could be the wife or other family members because of indirect effect from the addiction of the former, he adds.
According to both the psychiatrists, one reason associated with addiction is due to mental functions. Ngully in this regard says alcohol depresses the high mental function, during which the low self esteem become the highest and also have some pain relieving effect. Opiods are also pain relievers. “The person may be having a very intractable pain, not physical but psychological. The same area of the pain registers physical as well as psychological pain,” he explains. The person does not realise the intractable pain in his psychic which keeps on coming back. “This is the reason why they need the substance to relieve the pain.”
Stigma associated to mental health and addiction
“In our Naga cultural context, mental illness is still a big stigma,” Ngully points and this is also a reason why many land up in rehab centres though their need is a mental health facility.
“The parents or even the patient himself would not like to be labeled as someone who is having mental health problem but they don't mind being identified as an addict and even relatives find more comfort in saying that the son or daughter is an addict rather than saying having mental health disorder,” he states.
For instance, the psychiatrist says cases like bipolar disorders in a rehab is very challenging adding that in our Naga context, when a person is usually referred to mental hospital for treatment, “a lot of resistance is seen in parents as to saying that their son is not mad or not pakala but an addict.”
Stigma is also attached to addiction, as Pienyu underscores that when people come to know about our addiction, we experience some form of rejection in every level of society. “This very fact of being stigmatized and discriminated makes you feel low which will harbour some form of mild depression and low self esteem.”
Alcoholism which is more common among adults because of the prolonged period of abuse and the advanced stage at which they also come with physical illnesses, Pienyu says effects the mental health in the form of loss of confidence, bad relationship with family and social circles, lack of productivity at work, functional competencies, chronic absenteeism among others.
Is prohibition a good mental health indicator?
While today after considering a liquor prohibition of over 30 years, it may not be a good mental health indicator over the period.
In this context, Ngully recalls that there was a very severe case of addiction in the late 80s and early 90s when many lives were lost to substance abuse. “The prohibition was brought about in the backdrop of alcoholism being considered as the main culprit,” he observes.
That impact, he says ‘if felt maybe, after 20 years, meaning today affecting most of the families particularly surrounding Kohima and Dimapur which were the metropolis and the society became very alarmed.’ He adds, ‘during those days, we were not aware about mental illness and problems associated with it. It was considered devil possession or somebody possessed black magic.’
“At that time it might have been good for the people also. But over the period, it has not been a good mental health indicator,” Ngully says adding ‘prohibition or stringent law cannot change someone’s behavior nor stopped people from drinking or becoming alcoholics. One negative impact was leading to people imbibing spurious liquor.’
“When it is prohibited and when people continue to drink, it also has a mental health impact because inadvertently it create guilt complex in that person,” he points.
The case is similar and related with other substances like drugs being made a substitute of alcohol increasing substance use.
Peinyu also observes that the prohibition and way it is made available, is another reason why alcohol and drugs are abused to a high extend.
Effect of substance abuse and mental health on young people
As far as Nagaland is concerned, Pienyu says one of the issues with mental health problems especially with young people is related to some form of substance abuse, either drugs or alcohol, to the extent that it contributes about 20% of mental health problems recorded in the State Mental Health Institute in Kohima.
“Not every young people are vulnerable to addiction but maybe those young people who have such a personality whereby their tolerance for stress is low or have very low self esteem, high threat perception become vulnerable to addiction,” Ngully cites a case.
Some, even if they don't become addict, as they progress in life when faced with challenging situations, it breakdown into mental illness, he adds.
Although mental issue is not a big problem at this stage, sometimes inorder to avoid the stigma of being mentally ill, if you resort to your own medication, you may land up becoming an addict, he points.
According to Pienyu most of the clients start young. In the social environment, an instance where a person who is supposedly ‘clean’ but among his peers are drugs, weed and alcohol users eventually fall into the influence of substance use which is pervasive, he explains. One observation among college students, he adds are use of heroin like weed, sunflower. He adds other reasons include loose parental control or easy money etc.
The psychiatrist observes that stress and anxieties have become more evident and pace of life getting faster, so accordingly lot of people who are overtly stressed in their workspaces indulge in substance abuse which in itself is very addictive and destructive. Another concern for young people, he adds is the high rate of unemployment which is associated with frustration, depression, drugs and alcohol use.
Other than medical intervention, Pienyu says a general concern is the difficulty in motivating the individual to get treatment while keeping in mind that mental health remains largely stigmatized. Apart from rehabs, OST treatment, seeking medical intervention, other markers for management of addiction and mental health problems are from a Christian perspective seeking prayer support or counselors in these kinds of setups adding a good active family support.
“We also need the churches to contribute to the healing of the person because it is the most effective organization in our society... It is a clean and healthy circle which encourages good habits,” he asserted.
The psychiatrists advices that if there is a friend or family member going deep into these issues, one should stay connected with the fellow or talk to the person to seek help in the different services that is there.
