Wednesday, 25 March 2009

The status of mentally ill patients in Maldives; Story of S

The status of mentally ill patients in the Maldives is pathetic. The way they are treated is miserable. Their rights are grossly neglected, their needs are little understood and the services to address the mental health needs of the nation is inadequate.

Let me share the story of S.
I went to a house in Male' , hoping to meet a friend. But , I was informed that the person I was looking for no longer lived in that house and was given directions to another address. Just when I was about to get back to the taxi, a middle aged lady came and touched my elbow saying ,
'Can you do something for me?'
I looked at her, I saw teary eyes which were almost pleading with me.
I went inside again. And she said,
'I know who you are, thats why I am requesting your help. Can you please meet my son? Just for this once?'
I asked her what was wrong with her son.
She said, ' I do not know. But I have not seen his face for the past 8 months.'
I said,' But how is that possible, if he is living in this house how is it possible that you have not seen his face?'
She began to cry as she explained to me ...
' He has his own room, with attached bathroom. About 8 months ago something happened to him , he came running , looking very scared one night, one of his fingers were bleeding too....he went and locked the room and said, he will never open the room and he has not allowed any one of us in after that. I will put his food near the door and when none of us are around he will quickly take the food in and after he finish eating, he will put the plate ouside. It will be nicely washed. If he needed anything he will make a shopping list and put it along with the plate'.

I found it hard to follow a story like this. It was difficult for me to comprehend that a person could live in such solitary confinement in his own house.
The mother requested me to try and see whether he would open the door for me, she said he knew me, he had mentioned my name before this happened to him. So she felt he may open the door for me. To give a try , all she wanted to know was how he looked like now, the status of his room.....
I asked her about his past. He had a criminal history, had been released from prison and had a history of substance abuse. No past history of mental illness.

This definitely was not a normal situation for me and I wanted an exit because I was personally not convinced that I could be of any help to them at all.
But I saw this mother, her pain and something in me ...just made me move, go up to that door and knock.

I called out his name, once , twice, several times. After about 15 minutes I saw somebody move two of the top louvres of his window. I said, I am so and so and that I wanted to meet him and I would be very fortunate if we could have a chat.
An hour or more passed. I stood there hoping he would open the door. I asked the family members to move away because I realised he was able to see us.

He opened the door slightly, and looked at my face. He recognised me immediately , but looked behind to see whether there was any one else with me. I told him I was alone.
Politely he asked me to come inside .
I went in.

It was a neat room. Not a speck of dust. The bed was made, the room was mopped, every thing was in perfect order. Near the bed there were sheets and sheets of paper. I saw that these pages were all write a nonsensical script.
He was neatly dressed , but he definitely needed a hair cut.
He asked me to sit down. Gave me his chair and sat on the floor and said he was sorry but he only had about an hour left...even if it was for me he was not in a position to give more time.

My antennaes went up immediately.
What did he mean? I asked,
'So you have an appointment in an hours time?'
He nodded and said,
He was in the middle of a UN meeting, the helicopter would come to pick him up soon'
I asked him 'where is the Helipad?"
He pointed at the ceiling and said,'Can't you see, its up there'
I nodded and said pointing at the sheets of paper.
'So you are a busy man, I can also see that you have been preparing some documents?"
' yeah , I am writing a document , on how to change things around here, but this person here keep troubling me, he is troubling me all the time ...see he is here now, he is telling me that you are an agent, sent by the gang who tried to kill me some time back , he says that you have come on their behalf so I should not have allowed you to come inside...he says he will whip me again tonight because I have disobeyed him'
In about 15 minutes time, he disengaged from me, he was talking to himself, banging his fist on the bed and was in an obvious arguement with the person he was hearing and seing through his auditory and visual hallucinations.

Suddenly he looked at me and said,
'When I was in the prison I had met you, thats why I opened the door for you, I told him that you will not harm but he is still not convinced'
I nodded and replied,
'Does this person talk to you constantly, can you see him too?'
' YES....YES..he says I must follow his instructions otherwise he will harm my family , may be even kill my mother, thats why I don't open the door for any one, specially my family members.........................'
I felt so sad .
Here was a person who was definitely mentally ill , probably suffering from an early onset of paranoid schizophrenia. He needed to be under the care of mental health professionals, he needed to be hospitalised immediately.....but who will take him ? Which law states that he be taken for mandatory treatment????
Do we have a system of care which can reach out to this individual with such florid psychotic symptoms? Do we have a mechanism within our health care , social care system which can come to assist in the treatment of this mentally ill adult? or ...who will help in alleviating the burden that is carried out by the family members of this distressed family?
I informed the family that he was seriously mentally ill, he needed to be hospitalised, I had to educate the family on the nature of the illness, give them enough to read on schizophrenia.
But the family was scared that if they approached the state for help a police entry to take him to the hospital or Guraidhu could result in possible violence and their son may land back in the they felt it was probably better for him to be left alone this way.
Mr. S refused to go for voluntary treatment and still live within the confines of his room.


Anonymous said...

From what you have written, it looks like a case of possession. Now, you may believe this or not but, the irony is that, I have seen more people getting cured of such illnesses from exorcists than psychiatrists.

Exorcists believe in the possibility that such illnesses could be psychological or spiritual. But, most local doctors fail to even recognize such a possibility.

Unlike local doctors, foreign doctors at IGMH and other hospital do recognize this difference.

What's happening?

Is little knowledge dangerous? Or, is it a case of...

"E meehakah ingeynee e meehaku kiyevi fothehgai onna echche!"

aishath ali naaz, h.sea-side said...

Dear anonymous.
It is true that we often understand things from our own socio-cultural perspectives.
For the past several decades this is how mental illness was understood and treated in our country.
Therefore, I will definitely not argue about the power of our beliefs and the wonders of spirituality and religion and its healing power on the human psyche.

How ever, symptoms of schizophrenia and many mental disorders which we in maldives refer to as merely possession syndromes, have well defined universal criteria for diagnosis such as DSM IV diagnosis of mental illness or ICD10 of mental illness where in hallucinations and delusions are known symptoms of psychosis seen in disorders such as schizophrenia.
I accept, that it will be difficult to leave old books and move onto new knowledge , what would be ideal at the moment is to perhaps use both models if it convinces us that this can alleviate the distress of the patient, but neglecting one at the cost of the other would ultimately result in irreversible losses for the patient. Specially when clearly defined treatment methods which are universally acceptable are available.
Unfortunately not all doctors are experts on mental illness but are also human beings who carry their own psycho-socio cultural contexts with them while making judgements.

Anonymous said...

i respect your knowledge on Psychiatry. can u tell me the meanin of this aayath. Allah says in surath bagar(1) aayath no.(275) "Those who eat Ribâ[] (usury) will not stand (on the Day of Resurrection) except like the standing of a person beaten by Shaitân (Satan) leading him to insanity"

Anonymous said...

Those who eat Ribâ[] (usury) will not stand (on the Day of Resurrection) except like the standing of a person beaten by Shaitân (Satan) leading him to insanity.

Anonymous said...

I have read the comment from Anonymous about exorcists and your reply. Many of our Maldivians have deviated from our religion and many youngsters do not believe in any religion at all. However, I would assume that the particular patient's parents would not be like the patient as far as belief is concerened. On this assumption, could you advise the patient's parents to perform the 5 daily Fardh prayers (Farlu namaadhu) regularly and then after the zikr thasbeeh (ie 33 times Subhaanallah, Alhamdhu Lillaah, Allahu Akbar) recite the three surahs Ikhlaas, Falaq, Naas with Kursi and thereafter a simple dhua (in the local language) to Allah to alleviate the problems of the patient. Also to try and coax the patient through some learned person to perform the prayers (of course with cleanliness and wuloo)and to recite zikr and the 3 surahs and kursi. Agfraim