DNA India
07 April 2010
By Mayura Janwalkar
Mumbai, India

We feel saner within the compound walls than beyond them,’ psychiatric health workers of the Thane Mental Hospital say.

After years of having lent a patient ear to the troubled, there is little that can unsettle them. “We can work in any place now,” says psychiatric social worker Nitin Shivde. “Without compassion, this work is impossible.” The nurses, who have undergone 11 months of training for psychiatric nursing before joining mental hospitals across Maharashtra, are content with their choice. “The first thing we learn during our training is that we have to accept patients the way they are,” says Louisa Choudhari, a nurse in the field of psychiatry for the last 20 years.

Mental illness is of two kinds – neurotic and psychotic, explains Dr Sanjay Kumavat, medical superintendent, Thane Mental Hospital. While neurotic illness is related to thoughts and emotions and the patient has some knowledge of it, psychotic illness affects behaviour and emotions to an extent that the patient loses insight.

The conditions the patients suffer from vary in degrees. “Some patients who suffer from paranoid schizophrenia are difficult to handle and they are not always violent,” she says. “We have to find out where the problem lies.”

Snehal Waghmare, a nurse, feels it is important to develop a rapport with the patients. “While some take a few minutes to open up, others have to be observed over days,” she says. And to get there, they need to feel like they aren’t being judged. “They say horrible things about their husbands, mothers-in-law and others, but we have to just listen to them and not react. There is no room for irritation,” she says.

And when doing the talking, the exchanges have to be skillful. “It takes diplomacy to handle an innocent psychotic. He or she cannot be antagonised,” says Kumavat. The greatest challenge, he adds, is to get the patient to see a doctor.“To win their trust, a doctor sometimes has to play along the patient’s diktats.”

Choudhari, however, says those confined to their hospital wards harbour no malice and don’t play games. “They will abuse us to our faces and apologise too. There is no trace of pretence or hypocrisy, like there is in the world outside,” she says.

Choudhari shows us paintings made by one of the patients from her ward. “She used to be very violent and would tear her clothes. But she was educated, and when her mind was diverted to her talents, she could paint beautifully.”

Kumavat admits that empathising with neurotic patients can get him down, but sometimes shutting one’s clinic and mind are not options. The misguided relatives of the patients are far more difficult to tackle than the patients themselves, says Kumavat. “A mad person is always better than a half-mad person,” he says in jest.

Mental illnesses needs long-term treatment, says Choudhari, adding, “and our patients do get attached to us. But when they recover and go back home, we feel rewarded and tell them never to return.”