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One of the biggest challenges of dealing with mental illness is the fear and stigma associated with seeing a psychiatrist. But this need not be the case, says Dilip V. Jeste, associate dean for healthy ageing, and distinguished professor of psychiatry and neurosciences at the University of California, San Diego, US. As a global thought leader in the field of psychiatry, Jeste advocates a clinical approach, called “positive psychiatry", which is much less intimidating for people.

Jeste was in Mumbai in January to deliver the keynote address at a conference organized by the Dr NS Vahia Foundation, a non-profit working in the field of neuropsychiatry. Vihang Vahia, the organizer of the conference and a consultant psychiatrist at the Breach Candy and Lilavati Hospitals in Mumbai, says: “Traditionally, clinicians are trained to explore ‘what is wrong with you’. We then work on genetic-biochemical and psychosocial probabilities that might have contributed to the emergence of symptoms." He adds: “Jeste’s contention is that every ill person has several strengths that contributed to healthy life, before the onset of symptoms. These factors need to be stressed in helping the person get over an illness and get back to the pre-illness state of mind."

A different approach

Mental health remains a poorly understood concept in the field of medicine in India. What’s needed, then, is an approach with the patient’s well-being at its centre and one which makes it easier for patients to seek treatment.

Mental health professionals (including psychiatrists, psychologists, clinicians and researchers) specialize in behaviour modification through a combination of medication, psychotherapy and environmental changes. “When we are dealing with someone who is depressed, bipolar or schizophrenic, we are trying to change that behaviour. Positive behavioural change is the hardest thing to achieve when a person is thinking and feeling suicidal," adds Jeste.

Most of the time, psychiatrists simply ask for the main symptoms and prescribe medication; they do not assess the patient’s strengths. But “numerous studies have shown that these strengths, also known as positive psychosocial traits—such as resilience, optimism, wisdom and social engagement—are associated with better health, recovery and greater longevity. So we need interventions to increase these factors to improve health and well-being," says Jeste.

Positive psychiatry, according to him, is not merely the absence of illness, and the role of the psychiatrist must include assessing the patient’s strengths.

This approach has several consequences. First, it affects the entire healthcare system, as other healthcare providers, such as nurses, social workers and psychologists, are also involved, playing a key role in providing care and delivering the right set of interventions that enhance these positive traits. “There are not enough clinicians, and the care has to come from other caregivers," says Jeste.

Second, an emphasis on psychosocial traits necessitates different kinds of interventions compared to conventional drug therapy. One such intervention could consist of writing letters of gratitude to persons who have helped, or listing three things that one is grateful for at the end of the day (or the week), in order to improve levels of optimism and well-being.

Lisa Eyler, an assistant professor in the department of psychiatry at the University of California, San Diego, who was also at the conference, recently conducted a study where healthy older people were given drama lessons and taught how to act to enhance their levels of compassion and empathy. “Empathy and compassion, along with resilience and optimism, are positive psychological traits, which I think help people to have greater well-being, especially as they grow older. We have been interested in the types of interventions related to empathy and compassion," says Eyler. While the results of the study are still awaited, the nature of the study itself illustrates a new approach to psychiatry.

Behaviour modification

Finally, the third consequence of adopting a positive psychiatry approach is that it is applicable to a wider group of patients.

Jeste believes that psychiatrists have a much bigger role to play in the healthcare system, for they specialize in behaviour modification, which need not be restricted to those with mental illness. “We can also influence patients with physical illness. For example, take a 65-year-old man who smokes and drinks a lot and is obese. The treatment is not just aspirin or statins. It is to stop smoking, it is behaviour modification and healthy lifestyle," he says.

“We really need to change the entire healthcare system to shift the emphasis to preventive care from treatment. We can’t prevent cancer or schizophrenia, but we can reduce the risks of a number of illnesses if the lifestyle improves and we take a number of preventive steps."

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