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Mending minds

If you are excited by the human psyche and have compassion for the mentally ill, you will do well in psychiatry, says Pranab Ghosh

education Updated: Jan 20, 2010 10:07 IST
Pranab Ghosh

Case 1: Padma, 55, was afraid of venturing out. She was scared of street dogs, birds or even harmless stray cows. The dogs would bite her, the birds would dirty her with their droppings, or she might just step onto the cow dung — so she thought. She confined herself to her house for 12 years until her brother took her to a psychiatrist.

Case 2: Harish, 45, was afraid of lifts. Every day, he walked up to the 13th floor of his office building, until his wife made him see a psychiatrist.

Padma was given intense counselling and was gradually exposed to the world beyond her home, which included a trip to the zoo, where the doctor accompanied her to help her overcome the fear of animals. And Harish, following effective counselling, was asked to use the lift regularly.

Both underwent behaviour therapy, a form of psychotherapy that aims to help patients change their behaviour through a series of discussions between the doctor and the patient. Both are now free of their problems. Welcome to the world of psychiatry. “It is the branch of medicine dealing with the mentally ill,” says Dr SC Malik, director professor in psychiatry and senior consultant at Sir Ganga Ram Hospital. “It is a specialty that is involved in searching the causes of mental illness as well as their management.”

The scope of psychiatric treatment in India has increased over the years. “People earlier had the notion that psychiatry is about treating psychotic disorder, which means treating grossly disorganised behaviour — behaviour of violent people, of people who are not in touch with reality,” says Dr Rajesh Rastogi, senior psychiatrist and head, department of psychiatry, Safdarjung Hospital and VM Medical College, New Delhi. But things have changed. “Today, psychiatry is also about treating adjustment disorders — marital disharmony, adjustment problem between parents and adolescents, minor neurotic problems, drug addiction etc. It teaches people how to manage stress.”

Modern living is full of stress, which leads to anxiety, and the man in the street is not aware of it to the right degree. “The individual Indian, like any other world citizen, may or may not be aware of the nature of stress and anxiety, and unless these reach a disorder level, may not be too concerned with them,” says Dr Alok Sarin, consultant psychiatrist, Sitaram Bhartia Institute, New Delhi.

Dr Padmapriya Chandran, senior resident, department of psychiatry, Safdarjung Hospital and VM Medical College, is more categorical. “Indians are largely unaware of the importance of mental health,” she says. Dr Rastogi agrees: “Often, people are not aware that mental illnesses are treatable. They, especially those in the rural area, do not know about the places where the treatment is available.” Media, both electronic and print, can and does play an important role in spreading awareness, he points out.

There are, however, not many doctors around. “The number of psychiatrists in India is around 3,000, much lower than the number in developed countries,” says Dr Rastogi. The reason for the shortage may be attributed to the limited number of institutes in India imparting postgraduate training, and the fact that many doctors have gone abroad for better scope, he feels. The shortfall, however, means there is that much more scope for young entrants.

What's it about?
Psychiatry is the branch of medicine dealing with the treatment and prevention of mental illness. Mental disorders are characterised by a variety of symptoms, such as abnormal moods or behaviour, excessive anxiety and hallucination. Many mental disorders are believed to result from a combination of emotional, social and biological factors. To treat the patient, a psychiatrist might discuss problems with one patient, prescribe drugs for another, and combine discussions, drugs and therapy for third

Clock work
9 am: Reach hospital
10 am: Examine patients
Noon: Administrative work of the hospital
1 pm: Lunch
2 pm: Specialty clinics like child guidance clinic, psychosexual clinic
4.30 pm: Case discussions and seminars
7 pm: Call it a day
A doctor who is an independent consultant would have a different work schedule depending on the timings of the clinics he attends

The payoff
In a government set-up, the pay bands are Rs 50,000-60,000 per month (entry level), Rs 80,000-90,000 per month (middle level) and Rs 1-1.5 lakh per month (senior). In a private hospital, a doctor would get more or less similar pay. However, a senior doctor with a good practice may earn more than Rs 2.5 lakh per month

S/he must be a good listener
. Have a lot of patience
. Ability to strike a rapport with the patient
. Ability to empathise
. Ability to remain detached from the patient’s problems

How do i get there?
Take physics, chemistry and biology at the Plus Two level. Then clear pre-medical entrance and get an MBBS degree. After that, go for a postgraduate degree or diploma. There is a two-year diploma course (DPM) and a three-year degree course (DNB/MD). Further specialisations include child psychiatry, geriatric psychiatry, forensic psychiatry etc available in abroad

Institutes & urls
NIMHANS, Bangalore
. CIP, Ranchi
. PGIMER, Chandigarh
. AIIMS, New Delhi
. KGMC, Lucknow
. MAMC, LHMC, New Delhi

Pros & cons
. Satisfaction when a patient improves or is rehabilitated
. Very little physical exertion
. One can rise fast as India has fewer psychiatrists
. Some of stigma attached to mental illness may rub off on the doctor
. Earning not proportionate with the time spent on a patient, compared to other
branches of medicine
. You may fall prey to depression while continuously treating patients with mental

World-class facilities, more of the human touch

A senior teacher and practitioner talks about the scope of the profession

Does the mental health care in India meet the world standard?
Quality-wise, we get world-class psychiatric treatment. The expertise available is good, the human touch is much more, and the medicines and treatment facilities are at par with any developed nation.

Apart from hospitals, where can a psychiatrist work?
One can work with international agencies like WHO, Unicef etc, or with PSUs and government setups like jails, or large organisations that have their own medical facilities. One can also set up private practice. Other avenues are research or becoming an adviser at pharmaceutical companies producing psychoactive drugs.

How important is the role of a psychiatrist in the Indian medical set-up?
These days, due to increase in stress levels, mental health problems are on the rise. So psychiatrists have an important role to play. Lots of chronic medical patients develop psychiatric problems, hence consultation-liaison psychiatry has an important role.

How has the method of treatment changed over the years?
Previously, only a few drugs were available and our India Lunacy Act of 1912 was outdated. Now newer psychotropic drugs are available here. Treatment by ECT (Electro-Convulsive Therapy) and psychotherapy is available. We got a more humane and updated Indian Mental Health Act in 1987.

What are the challenges facing the profession?
Shortage of manpower is one major challenge. Add to this the uneven distribution of psychiatrists in rural and urban areas.

The undergraduate medical curriculum needs a change, too — teaching hours need to be increased and psychiatry should be made a separate discipline, not under medicine, for examination purposes.

Society (even now) stigmatises people suffering from mental disorder. This has to change, and the stereotyped presentation of mental patients in films or plays should also be avoided.

Dr Rajesh Rastogi, senior psychiatrist and head, department of psychiatry, Safdarjung Hospital and VM Medical College Interviewed by Pranab Ghosh