Stigma and Empathy – inverse correlates in the wandering mentally-ill

From the desk of Editor: Guest Editorial by Dr Bharat Vatwani

Volume 12 Issues 10 October, 2022 

Mental Illness carries a stigma – either Social Stigma or Self Stigma. Stigma causes mentally-ill people to feel ashamed for something that is, in reality, out of their control. There is exclusion, poor social support, isolation, loneliness and low self-esteem. Stigma prevents the mentally ill from seeking help and remains the cornerstone of stumbling blocks in addressing mental Illness. Neither the patient is ready to disclose his problems to himself or others, nor‎ is the relatives prepared to accept the situation for his mentally ill loved one or others.

Ultimately, mental Illness is boxed in, closeted, riveted, festooned and plummeted; with no breathing space, the claustrophobia of thoughts, emotions, actions and treatment options sets in.

The Illness starts multiplying internally manifold, literally becoming gangrenous in form. At a subconscious level, it ultimately manages to expunge the mentally ill from within themselves, their families and their societies. And thus, is born the WANDERING mentally ill. The wandering keeps the mental Illness (at a subconscious level) in stagnated momentum, like a rolling stone, gathering no moss. No further additions/subtractions are there to the psychic maelstrom, and the wandering becomes a way of life. The schizophrenic man, walking/disconnected from society in an attempt to drown his anxiety by the physicality of his momentum, his wandering.

Shraddha addresses this physicality, this momentum, this wandering. As Psychiatrists, we have two options

We continue to deny them their existence, shun, reject-neglect them unto infinity, and so, allow their stigmatisation to compound subconsciously in our minds, in the minds of lay society and in the psyche of the wandering mentally ill themselves. Or We show them Empathy, take them into our shelter and fold. Mental Hospitals get such “unknown” patients brought by police, and there is no relative/caregiver to hold anyone accountable. And if we, as Psychiatrists, do not empathise with them, how can we expect others to ?

Role of Empathy:

The key to connecting to the wandering mentally ill is Empathy. By voice, body language, demeanour, eye contact and soul contact. Empathy is neither pity nor benevolence. It is beyond. It is the natural ability to communicate to the man on the streets that ‘There, but for the Grace of a God above, go I. Therefore, I am you & you are I’.

The moment True Empathy is established, the claustrophobia of thoughts, emotions and actions festering within the psyche of the destitute yields like a pricked balloon. They agree to receive the proffered help.

Anecdote A:

While travelling by train, our Social Worker (SW) Farzana Ansari came across a mentally ill male destitute male on the railway station platform, established rapport, cajoled him onto the train and brought him to our Centre, a good 10 hours of travel time away.

Anecdote B:

Students from neighbouring colleges who have had exposure to our work can induce the mentally ill wandering destitute to sit on their motorcycles and bring them to Shraddha.

How did she/they achieve this? The communication of Empathy. The communication of ‘I am you, and you are I’.

Nobody has ever given a bath to the destitute or attended to his basic hygiene. He/she/they have never thought of it themselves, the stigma internalized and revulsion to their Illness having set deep for months/years/decades. The Shraddha staff penetrate the psychic wall, the jungle of matted hair and beard is cropped and trimmed, and fresh clothes are provided. Accepting them as human by the staff makes them take themselves as humans.

John Milton’s Paradise Regained, albeit the glimmer of it.

The patients are persuaded to, pleaded to, in gentle, soothing tones to come forward with their names, their parent’s names, their sister’s names, the names of their husband/wife, their children, their kith and kin, the name of the village where they were born, the district to which they belonged, the school in which they studied, the movie theatre in which they saw their favourite cinemas, the festivals which they celebrated with their families, the Gods which they revered and prayed to. Questions that no one had ever asked them before, and questions the answers to which they had almost forgotten themselves. The capacity to make a wandering, mentally ill destitute believe that he has an identity and belongs. Simple questions, no rocket science, but interpersonal rapport at an Empathy level.

Psychiatric medication is initiated.

From day one, the patient is addressed by his name to re-establish his sense of identity. Coming to know of their specific skills, the patient is incorporated into gardening, farming, masonry, electrical repair work, cattle attending, cooking, vegetable cutting and general cleaning. The needy believe his contributions are unique and valuable and will be cherished even after he has left the Centre. The unfurling of the nuances of their inherent personality. A bygone psychic era, recreated. The balloon of stigma pricked further.

The doctors at Shraddha have an SOP to have all the patients present while taking their rounds. The tone, body language, demeanour, and eye contact may communicate Empathy for one. Still, its visual and aural presence in front of the others disseminates Empathy to all within the room. Every one of the impoverished presents realizes that there are caring, concerned people addressing each of us individually.

The presence of the entire team of social workers, hailing from different States and speaking different dialects of India, makes the patient belonging to a particular State/District/Taluka comfortable because they are addressed in a regional language/dialect that they understand, which they have grown up with, and which has become a part of their Jungian collective unconscious psyche. This often results in an ab-reactive emotional catharsis by the patients.

Anecdote C:

A patient broke down and, spontaneously reaching out for a pen, wrote a mobile number in his tremulous handwriting.

Humans, establishing and proclaiming their rights to be human, and interpersonal emotional rapport weaving its magic.

Stigma and Empathy thus become inverse correlates in the differently-humane broad-spectrum-gestalt functioning of Shraddha.

NOTE: The continuation of the article title as “Management of the wandering mentally-ill roadside destitute” by Dr Bharat Vatwani, published in Volume 12, Issue 11, November 2022 (publish soon)