The brain not only controls our action, intention, and personality; but also offers storage space for our vast experiences as retrievable memory of various sensory perceptions. It receives information and orchestrates complex behavioural series that allows us to act in sometimes amazing, and sometimes dreadful ways. The “self”, as in what we think, remember, can do, and how we feel; is acquired by the brain from the experiences that occur after birth. The useful experiences and abilities are rehearsed to perfection through the marvellous circuitry and neurochemistry of the brain, and their manifestations on the body. And while we dream in sleep, it is the brain that creates a story, filling it with actors and scenarios, and generating hallucinatory images.
While biologists contend a set of genetic behavioural determinants, our behaviour is also the consequence of events occurring in the brain, and their effects on the body and our motor and sensory faculties. In my opinion, our personality is ever shifting, fluid and is akin to an ‘Identity Card’ that we hang around our neck for others to know us, albeit with limited validity because details on the card change with time and do not exactly match with the person we know!
Personality changes that come with psychiatric afflictions, and those that interfere with the person’s normal lifestyle and interactions with people around are worrisome. But branding someone as insane without expert evaluation and advise is inappropriate.
Among the many negative attributions that we despise deeply, being called ‘mad’ tops the list. The substitutes of this unfair ascription are crack, mental, gone-off, and loose in head and can damage reputation of individuals and eventually end up branding them as different and abnormal.
Attempts by relatives to label their legally inherited ‘burden of old age’ as mentally ill and evict them from their homes are not as uncommon as one may think. In such situations the irritations, anger, confusions, lethargy and mood swings of old age get misconstrued as psychiatric illnesses and hyped by the care giver to seek sympathy.
On a philosophical note, madness implies that we set a predetermined and often prejudiced scale of normal or good behaviour, and generally believe that majoritarian behaviour or conduct is normal and sane. There can be cultural differences in our perception of what is normal and what is insane, just as interpretation of insanity must be contextual. Madness can therefore be excessive engagement with something to the extent of ignoring other priorities and incurring a health cost.
From a medical perspective, madness is a collage of emotions and behaviour characterised by irrational anger, aggression, fear, frustration, confusion, exhaustion, isolation, conceit (megalomania, narcissism, self-dramatisation), cowardice, and social antagonism.
After bereavement, a living partner often experiences loneliness, and their longing for attention from their children can become acute. The feeling of dependence, isolation and lack of socialising can add to the torment and manifest into irritation, anger and restlessness. Dementia, a common affliction of old age causing loss of cognitive abilities such as thinking, reasoning and remembering; brings about drastic changes in personality. Alzheimer’s disease is a progressive type of dementia with phased change of personality and rapid mood swings marked by aggression, agitation, and paranoia.
My mother suffered an ischemic brain stroke at the age of 75, was paralysed and suffered loss of speech. She was bedridden for over a decade, completely dependent on us for her alimental needs and hygiene. She endured intermittent seizures and had bouts of frustration, anxiety, anger, hopelessness. She often conveyed to me in sign language that she desired to die rather than live such a life of extreme dependence and hopelessness. She’d often create mess on the bed with her diapers, and I have sat cleaning her with lot of empathy and affection, while she stared at me with blank gaze. I ensured that there was no dearth of love, compassion and empathy.
My father suffered severe anxiety and suddenly one day declared that he had become a pauper, with not a rupee in his bank account. I reminded him that he is a pensioner with regular credits to his bank account. But he insisted on visiting the bank immediately and I drove him to his bank in Vasco with his urine catheter and bag in place, to the irritation and horrified expression of the bank staff. Certainly, that wasn’t a normal conduct, and yet I had the satisfaction of relieving his anxiety.
Some years ago, I had a student of my first batch in 1988, visit me in the department. She walked in with a stick in her hand; looking emaciated, exhausted, suspicious and scared, her dress was dirty and hair unkempt. I told her that most of her teachers had retired and asked her the purpose of her visit to my department. Her response was perplexing and confusing, she said she wanted to donate her ova as she was under threat from Mossad, the Israel Intelligence agency! She then showed me some legal documents, saying that her property was under siege by the spy agency and instructed me to speak softly because the spy satellite was listening to our conversation. I offered her a seat and then politely got her engaged in conversation and later respectfully ushered her out of my department.
The point is that the human brain is complex and unfathomable. It is the chief seat of our behaviour, but the departures from the ‘common sense reality' that we collectively call as “mental illness” are intimately connected with the surrounding culture and situations we find ourselves in. We need to be aware, empathetic and attempt to help these victims with proper diagnosis and treatment.
