I remember once getting a call from a person, who claimed to be a well-known public figure. He wanted a consultation for his son, who was apparently behaving in a very 'abnormal' manner.
Two days later, he cancelled the appointment fearing stigmatisation. A month later, he came to visit with his wife and son. The son was in severe depression, and had attempted suicide several times. In the interim, they had sought help from a person who claimed to make their son 'normal' through some 'secret rituals'. When that failed, they realised they had to seek medical help. But they preferred not to put their son on medications, again fearing social stigma and side-effects of 'mental blunting' and drowsiness. Hence, they avoided seeing a psychiatrist and came for 'counselling'. They requested me to do everything I could in one session, as they did not want to come again. It was a mammoth task to convince them to bring their son for regular psychotherapy sessions and follow-ups. Fortunately, they agreed, and we successfully resolved his difficulties over a few months.
Later, I pondered over the matter a lot. I thought there must be many such individuals, who feel thoroughly confused about which professional to approach. They fear social stigma about visiting a mental health professional. They end up faultily diagnose themselves, based on their misconceptions and trips to quacks.
I realised that at the root of it all is the highly stigmatised concept of 'abnormality' and 'abnormal behaviour'. People generally think of abnormality and normality as two distinct classifications. "Crazy", "going-mad", "mental", "pagal", "abnormal", "mentally retarded" are oft-used terms, which convey a disastrous and irreversible picture of the mental health of a person. Quite contrary to the truth, the general notion is that these so-called 'abnormal' people are sick and cannot be treated. Often, their families desert them and they are left on the streets to live a sub-human life.
It is not only this severely ill population, but quite a sizable population of 'sub-clinical' individuals who need professional help. These individuals are found aplenty everywhere—from MNCs to schools to government agencies to the poverty-stricken slums. These individuals or those around them either find it difficult to identify and understand their problems, or may not have the means or the courage to seek help from a mental health professional. With the rise in stress levels in our lifestyles, there are a huge number of people being affected by lifestyle disorders, whose behaviours lie virtually on the thin line separating normal from abnormal. We all go through critical phases in our lives, when in some way or the other we feel we are not our 'normal' selves. This really brings us to a burning question: Who then is abnormal?
Abnormal behaviour defined
To define the 'abnormal', we need to first understand the concept of 'normal' and 'normality'. Normality is based on our socio-cultural norms. Hence, behaviour that is in-keeping to an individual's socio-cultural standards is considered 'normal', whereas, any deviation from such standards is considered 'abnormal'.
However, abnormal behaviour can be said to be characterised by the four Ds:
- Deviant: from societal [or individual] norms
- Dysfunctional: the individual is affected such that s/he can not carry out his/her normal life
- Distress: such conditions result in distress for the individual
- Dangerous: becomes harmful to self and/or others around him/her.
Abnormal behaviour then is any behaviour, which is deviant from our normal behaviours and which leads to some or total disruption of our normal lifestyles, and causes distress to us, such that it may lead to dangerous consequences for ourselves and/or others.
Now let's understand the role psychology plays in dealing with abnormality.
The truth about mental disorders
All mental diseases are not madness
Mental disorders are just like physical disorders. They have a root cause, which leads to the development of the symptoms. Most mental disorders have a known brain basis. Hence, just like diabetes is caused by a deficit of insulin in the body, mental disorders like schizophrenia or OCD or depression all have a known deficit in different brain-chemicals, called neurotransmitters.
Just like one must manage diabetes with regular medications, mental disorders, like those mentioned above can be managed with regular medications. Besides medications, however, research has proved that psychotherapy is also essential and leads to faster recovery than with treatment only with medications. After all, when dealing with something as unique and complex as the human mind, medications are not enough to tackle the problems, unlike that in physical disorders.
Hence, the common misconception that mental illnesses can not be cured or that abnormal people are "gone cases" is false and have no base in reality. Science has proven that with adequate treatment by trained professionals, mentally ill individuals can be return to society to contribute fruitfully and evolve in their individual lives. Hence, this is the role of a clinical psychologist in the treatment of the mentally ill. But it does not stop there. As mentioned before, clinical and non-clinical alike, we all go through phases in our lives when we seek help. So, going to the right professional to seek help is not that bad, is it?
Who to see when you feel troubled and want to stay well
The work of a clinical psychologist covers a wide spectrum. Although most specialise in a specific area, due to the scarcity of professionals in our country, we have to cater to diverse demands. Generally, a clinical psychologist works in:
- Assessment, using psychological tests, and making psychological profiles of children and adults to aid in understanding their problems. This may involve making personality profiles, career aptitude profiles, neuropsychological profiles [for brain stroke, head-injury and neurological problems], learning disability profile or assessment of intelligence.
- Psychotherapy and counselling to help individuals grow out of their problems towards their goals in life. Often, this roughly corresponds to a multitude of objectives: helping someone find his/her meaning in life, helping an individual in career guidance or changing the way one looks at the world, or helping couples repair their relationships or empowering a child to understand his emotions better or correcting certain dysfunctional beliefs which leads to a faulty perspective.
- Behaviour training for children and adults, to help manage behaviour problems; in training children with developmental disorders to help them learn vocational and life-skills.
- Stress management, lifestyle management and self-development programmes [popularly termed as personality development in self-help books].
- Rehabilitation of individuals with long-standing severe illnesses and brain damage, to empower them to lead better and more productive lives in society.
A little help
We all go through periods in life when we feel stagnated, and feel a tremendous need to grow. We also experience emotions in the ups and downs of life, which we feel no one might have experienced before. We all complain about not being able to cope with stress and feel the burden of life every now and then. Some of us have had terrible experiences in the past, which leads to our present day problems. But, the complexity of the human mind makes it impossible for us to understand how we develop such problems from seemingly minor issues or devastating experiences. At the same time, there is this tremendous human need to stay well, to complete one's circle of life. This pushes us to a state of disequilibrium, when we want to do something, but we are unable to do it.
This is when all of us wish we had somebody who could understand us the way we are and why we are the way we are, and how we could help ourselves grow. Often, we settle for a family member, a spouse, a friend to talk about such things, but deep inside, we know, often it does not answer our questions. This is when a clinical psychologist is who you need to see. With the acumen of a scientist and the empathy of an artist, a clinical psychologist helps you understand yourself better and helps you in solving or managing your problems.
A clinical psychologist's chamber is open to anybody who feels the need to change something about his/her perspective in life.
Psychology experts and You
Often people confuse between a neurologist, a psychiatrist, a psychologist and a clinical psychologist. A neurologist is a person who has a background in medicine [MBBS], and has then further specialised in neurology [MD]. A psychiatrist too is a doctor [MBBS], who has further specialised in psychiatry [MD]. A psychologist is a person who has studied psychology in his graduation and post-graduation, without any specialised training in any area.
A clinical psychologist is a psychologist with specialised training [mostly of two years internship in M.Phil. at a nationally recognised mental hospital] in the different mental disorders and their treatments. They are practicing professionals who are involved in diagnosis and treatment of mental disorders and difficulties. The difference between a psychiatrist and a clinical psychologist then is in their background in graduation, and their perspective on treating mental disorders. A psychiatrist, further, can prescribe medicines, if required.
A clinical psychologist, because s/he does not possess a degree in medicine, is not eligible to prescribe medicines. However, it must be remembered that clinical psychologists, as part of their rigorous training, learn about the different medicines that are prescribed in mental disorders, and must be aware about their side-effects profile and contraindications. Most often clinical psychology use psychotherapy as a method of treatment. Associating mental disorders with madness and humiliation is another huge reason why people hesitate going to a clinical psychologist.
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