Psychiatry Consultations and Counselling Services  in  Goa, India 

Difficulties in Treatment

by  Ashutosh Prabhu Dessai

People face difficulties in accepting or pursuing psychological treatment due to various reasons which are different for different people.

Apart from practical difficulties such as long distance of the clinic or hospital, long period of treatment, cost , finding a compatible, competent and knowledgeable therapist etc., psychological or social difficulties will be discussed here .

1.Stigma

Some feel uncomfortable at the thought of visiting a clinic itself due to presence of other people who will know them, some others are hesitant even to come to a multispeciality hospital due to being identified by  medical or paramedical staff and would rather suffer incapacitation than go for therapy.

This discomfort needs to be addressed in therapy as it prevents the initiation or continuation of therapy. Many people without any disorder visit a psychotherapist because they need help with a variety of academic, personal, family, marital , sex, love,  sports, weight loss, related issues. Therefore mere visiting a therapist need not be construed to be equivalent to illness.

Sometimes even adolescents will refuse an assessment even for scholastic difficulty because they will be labelled mad if they went for an assessment.

Sometimes even the highly educated and professionals wrongly believe that because they have a weak mind they have developed symptoms or have been exploited by cults etc. even though in their case they have no inherent disorder and the symptoms are induced by a stressful environment eg. marital discord or abuse. As a result they blame themselves, lose hope and become depressed.

This misconcept is widely prevalent and discounts the fact that human brain is susceptible to harm from external influence and leads to large number of people harmed by control and abuse prevented from receiving support, sympathy and treatment and are infact neglected or abandoned by their loved ones, friends and family and left to their fate.

Sometimes spouses or family develop a feeling after learning of the person's diagnosis that their partners productive life is finished and that entire burden of providing for the  family, raising children etc. now lies solely on them . As a result they panic,  lose hope  and may start controlling all his/her actions, finances and /or calling him names, blaming him for small mistakes, shouting, saying derogatory  remarks that he is useless, mad etc. worsening the problem and even inducing depression. This besides leading to constant fear of getting divorced can at times actually culminate in divorce.

2. Ignorance

Sometimes even paramedical personnel may say to a well groomed person why he/she at all seeks a consultation instead he should pray or do social work giving the client a sense of frustration and making him  angry at his inner suffering being discounted.

Sometimes spouses or family fail to understand why the patient who looks hale and hearty says he is suffering and tell him to just remain busy and that there is nothing wrong with him thereby discounting the suffering, denying the person a right to be unwell, discounting his reports, and thus invalidating the person and depriving him of their sympathy and possibly adequate treatment which he needs and deserves. This induces a sense of helplessness and powerlessness in the client that not only can he help himself but is not understood by family and therefore is not going to receive the care due to any other ill person depriving him of hope, making him worse and even suicidal.

At other times however spouses or family interpret even normal behaviour of a person who has received a misdiagnosis, as abnormal. Such clients have to undergo non indicated treatment as a result, for prolonged periods or atleast suffer needless stigma and consequent ridicule and abuse. Such presentations of normality, though rare, are nonetheless seen and needs a few months of exploration for a definitive diagnosis.

Sometimes parents or family outright, unjustifiably deny patients reports about he getting stigmatised in society eg. when the client has abnormal drug induced movements, saying no one talks about him and he is just imagining it. Thus he is denied an opportunity for appropriate treatment for the complaint like involuntary movements which force him to remain home unproductively for years thereby inducing demoralisation.

Some relatives or parents or even patients magically expect above difficulties to be treated in a single session and that too only through medications and not therapy and reject explanations for need for treatment for few months to a year.

Sometimes even a person who has a non psychotic condition is at a loss to realise how he/she is behaving and hence refuses all treatment. This scenario may continue despite months of therapy where no insight may develop.This can induce a lot of frustration for family members who suffer as a result of clients dependant, clinging, needy or intrusive behaviour and can make them to seek therapy for themselves to alleviate their distress.

3.Motivation

Having a commitment to doing therapy regularly needs a strong resolve due to which many find it difficult to commence or continue therapy.

4.Shame

Some clients find it a daunting task to have to discuss embarrassing emotions and feel it rather uncomfortable and therefore may avoid therapy or seek ingenious ways to terminate it.

Some family members prefer not to report even severe problems like the client wandering away from home to the authorities and suffer in silence for the fear of adverse publicity in media which may get generated due to their high ranking public positions.

5. Magical expectation

Some clients harbour magical expectations that their symptoms of difficulty in functioning, to improve dramatically with psychotherapy and/or medication treatment so that they are able to enjoy life, without they being able to cope with or correct the underlying cause of the problems, even  when it is an external stress  ( not an inherent brain disorder ). Such magical practice of psychiatry is virtually impossible with the current state of advancements in psychiatry.

6. Valuing money over life

Some people fail to appreciate the value of life spent in years of not being functional and live with disbaility rather than be willing to spend on treatment as they give greater importance to money than themselves.