By Dr Javed Latoo, Psychiatrist
Psychiatry is a branch of medicine that deals with disorders of the mind. The mind has a physical understructure called the Brain. According to the most accepted current theory of mind, Functionalism, the brain is like a hardware and mind is like a software of a computer.
The brain is the most complex organ of the body even though it weighs only three pounds on an average. Some of the hair-raising facts about brain include that on average a brain contains about 100 billion brain cells called neurons and each neuron connects with about 40,000 synapses. It is estimated that a human brain can generate around 50,000 thoughts per day. Due to such complexities, the brain is often referred as the "three-pound universe."
Even though we use the brain and the mind for every action, their complete functioning is still hidden from our plane sight, and unfortunately, our eyes cannot see beyond our noses. We still don't know a lot about the Brain. However, due to advances in brain imaging technology and neurosciences, our understanding of the functioning of the brain and its role in mental illness is improving and is going to improve vastly over the next two decades. I believe a forest of new knowledge about the brain and mind is waiting to be discovered.
However, due to the nature of the territory psychiatrists deal with, there may always be an element of uncertainty about the exact nature of things as Psychiatric disorders develop at the fence of the matter( Brain) and non-matter ( Mind).
Psychiatry is not the only branch of medicine or science that is shrouded in a degree of uncertainty. We now know even our physical world, we are so certain about, is characterised by uncertainty and unpredictability at the Quantum ( sub-atomic ) level. The Uncertainty Principle, also known as Heisenberg's uncertainty principle, in the field of Quantum Mechanics was proposed only to highlight our limitations to know things with certainty. The principle of uncertainty was considered a blow to the believers of absolute Determinism.
Even though we do not know the exact cause of chronic psychiatric illnesses like Schizophrenia or Bipolar Disorder, but we know a lot, indirectly, by the effectiveness of medication and their mechanisms of action. Various psychiatric medications including antipsychotic and mood stabilisers are very effective drugs that help many patients to live a productive life in the community.
Regarding the exactness of causality, it is important to emphasise here that psychiatric illnesses are not different from physical health conditions. There are many physical health problems ( too many to produce an exhaustive list here) where we do not fully understand the cause of the condition. In many physical health conditions also, ( e.g. Hypertension, Cardiomyopathy, Parkinsons Disease, Multiple Sclerosis, Sarcoidosis, Pulmonary Fibrosis, Bronchiectasis, Ankylosing Spondylitis, Chronic Fatigue Syndrome, Autoimmune Hepatitis, Ulcerative Colitis, Crohns Disease, Fibromyalgia, types of Glomerulosclerosis and Arthritis), we do not know the cause of the condition.
In the medical field, we often use a word idiopathic when we do not know the exact cause of the problem. For example, In 95% of essential hypertension cases, the cause of the hypertension is not known. However, we still treat them with medications including anti-hypertensive to stabilise blood pressure and reduce risks associated with high blood pressure.
Curability and chronicity
There is another misconception among doctors as well as the public that most physical health conditions are curable as compared to psychiatric disorders. I probably would run out of space to mention all medical conditions by name that cannot be cured like some mental illnesses. My colleagues in Primary care, Internal Medicine, Cardiology, Respiratory Medicine, Neurology, Geriatrics, Rheumatology, Dermatology, Oncology and many other medical specialities spend most of their time in the management of chronic physical conditions that can only be treated but not cured.
Hypertension, Ischemic Heart Disease, COPD, Bronchiectasis, Rheumatoid Arthritis, Diabetes Mellitus (DM), Osteoporosis, Parkinson's disease, Multiple Sclerosis, AIDS, Chronic Liver Disease, Chronic Kidney Disease, Hepatitis B, Hepatitis C and SLE are just some of the chronic physical conditions that immediately come to my mind. Just like some psychiatric conditions, these physical conditions are treated to improve symptoms, improve the quality of life and reduce risks without any permanent cure.
On the contrary, many patients who develop a depressive episode might not have another episode and thus is potentially a curable disease. One fourth of Schizophrenia patients have only one episode and can achieve complete recovery with medications.
Just like many chronic physical conditions like DM, COPD, Asthma, Arthritis, Hypertension and Parkinson's Disease, many psychiatric patients would need long-term treatment to stabilise symptoms and improve the quality of life. Treatment significantly reduces relapses, readmissions, and risks to themselves or others. Most of the psychiatry conditions can be successfully managed, and patients can make a reasonable recovery on various effective treatments available including medication and talking therapy.
Just like physical conditions, including Hypertension, Diabetes, Ischaemic Heart Disease, COPD, and Asthma, many psychiatric patients may need more than one medication to control symptoms. In short, both psychiatric and physical conditions can be chronic as well as incurable, but they can both be treated to minimise symptoms, reduce risks, reduce hospitalisations and improve the quality of life.
What needs to change
We, as doctors, need to change our attitude by improving our knowledge about psychiatric conditions. Both physical and psychiatric conditions can be idiopathic (unknown cause), treatable, curable, incurable, acute and chronic. Both, physical as well as psychiatric conditions, may need short term or long term treatment. Both may need one or more than one medication or treatment to reduce symptoms. Moreover, both types of conditions can be treatment resistant. Education should start at medical school when attitudes are developing.
We need to educate patients by drawing comparisons between psychiatric and physical conditions. In my clinical practice, I have found these comparisons very helpful and efficient to educate patients, carers and healthcare professionals about the causation, treatability, curability and prognosis. Above all this education helps to infuse a hope. It also contributes to improving compliance with treatment as well as the acceptability of the diagnosis and management.
Awareness about the uncertainty being a feature of whole medicine and physical world is vital. It is important to impart a hope by talking about treatability as well as potential curability of psychiatric conditions by drawing comparisons with physical conditions. Such an approach may go a long way in combating the stigma of mental illness among patients, carers, and healthcare professionals. I believe, given the complexity of brain and mind, psychiatrists need to have the shoulders of an ox. They not only need to treat their patients but also become advocates of their vulnerable patients and educate both patients as well as their medical colleagues in other branches of medicine.
Take Home Points
Cite this article as:
Javed Latoo (2017). Causation and curability in psychiatry and other branches of medicine. The Beautiful Space-A journal of Mind, Art and Poetry. March 2017: TBSB114
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