‘There Is hope, even when your brain tells there isn’t’ – Unknown

 As I embarked on the journey of my Specialty Training in Psychiatry, I took it as my moral duty to talk ‘a lot’ about Mental Health. To associate and identify with it, to normalise it as I would an odd headache or a runny nose. Talk about mind and feelings, passions and reactions, anxiety and trauma, depression and drug use. Talk about it being okay, not being okay. One of the biggest dilemmas we face in today’s day and age when it comes to illnesses of the mind is the culture of ignoring, minimising or altogether disregarding the possibility of the same.

There is little doubt that the twenty first century human brain, stands prone to trauma and breakage. Inadequate safety networks, vulnerable mindsets, fragmented relationships, unrealistic socioeconomic competitiveness and a perpetual strive with negligible passivity in the daily grind renders this scrambled lifestyle a perfect breeding point for less than ideal attitudes and behaviors.

As per NICE Guidelines that we follow here in the  UK Management of Psychiatric Illnesses can be broadly discussed via a model often referred to as Bio Psycho Social Model. The focus here is laid upon three crucial aspects of treatment ; Pharmacotherapy or Medication, Psychological Therapies, and more importantly Social Intervention. The expected knee jerk reaction to any mental or physical health issue is pharmacological intervention, conveniently ignoring the crucial importance of basics like effective social networks. There are countless pills and potions but as per evidence and experience the efficacy of any intervention is increased significantly if additive of positive social and interpersonal circumstance As a psychiatrist I see countless cases where the Inadequate network of close relationships is a major perpetuating factor to multiple affective disorders.

Unlike many Physical Health Diseases, where its fairly straightforward to spot an illness, it’s extremely complex to detect an underlying Mental Health Issue. And this is where the importance of adequate Social Support lies.

We dwell in an age of persistent precipitating factors and human brain stands prone like never before. However it is extremely resilient and would initially contest the challenges, as it starts to get overwhelmed it resorts to utilization of coping mechanisms and defense strategies. Its therefore long before signs of any malfunction start to appear despite the mind being overburdened and distressed. The subtle signs of a bigger mental crisis may be perceived as normal and seemingly unreasonable attitudes may be mistaken for social inadequacy, rudeness or lack of manners and that we may fail to recognize could be an underlying struggle within mind and it’s works.

Behavioral changes like anger or agitation may be a sign of underlying anxiety, avoidance and isolation might point towards a growing agoraphobia, being hypervigilant and getting excessively startled, are some of the features that can be seen in PTSD ( post-traumatic stress disorder), defiance and challenging behavior in children may suggest Conduct Disorder, and the list continues. Many of these indicators are ignored and forgotten while the storm within the individual may continue to brew; sadly un noticed and un-intervened . I therefore cannot stress how important nonverbal, not so apparent cues may hint to deeper rooted issues.

Developing countries like Pakistan don’t have substantial pots of cash to splash out on expensive projects, However what we can do is work with the strengths and resources we already have and build on them. The importance of Social Workforce cannot be denied. By Social Workforce I refer to the intricate network of friends, family, near and dear ones. This is one aspect that Pakistan is well equipped with in terms of manpower, however what is slightly challenging is how to ensure that workforce ( which is essentially us all ) delivers effectively. It’s crucial that Primary prevention start at places closer to home.

Modest steps sometimes bring the largest impact. It might not be very dreary a task, to spare moments from our screens and cast an eye on those near us, offer a patient ear, extend a helping hand, to help, and to be there ( in whatever capacity one can)when things take a tow for nears and dears ( or even complete strangers)

Not on all occasions would you meet with encouragement, people going through rough patches would seldom engage in niceties, they wouldn’t be weighing social approbation of their relative interactions. Expect to be ridiculed, misunderstood and often misjudged. There’d be projection, displacement and transference. These are some of the challenge we face every day as health care professionals, however for the bigger good of the community, I believe we as a force, as professionals and as members of the general public need to extend this attitude beyond just the confines of work. There would be instances when you’d make someone’s day a little better, a little bearable. Help someone see that silver lining ( however short lived) and a brighter perspective of seemingly dim and dark situation. Identifying concerns at prodromal stage can ensure timely intervention which combined with professional support can bear better prognosis.

Little things are vital. These seemingly little things add up to impart a greater difference. A helping hand , a stepping stone, a cup of tea, a kind word. That’s a step towards a slightly better day, a slightly better mind. And that’s where we start !

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