Conference Paper

 

 

 

 

 

 

 

 

 

 

 

 

 

INTRODUCTION:-

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After decades of ignoring or minimizing
the prevalence and effects of negative events in childhood, researchers have
recently established that a broad range of adverse childhood events are
significant risk factors for most mental health problems, including psychosis.
Researchers are now investigating the biological and psychological mechanisms
involved.

This paper deals with the issues
relating to role of adverse childhood experiences in mental illness and how
they are experienced by different people who are facing them and who have just
observed them. The focus of my paper is to take out the various adverse
childhood issues that are the root cause for mental illnesses. The issues and
the experiences which the children face that lead to mental illnesses, the contributing
factors to and the after-effects of these mental illnesses.

 

Description of
the Agency and my engagements in My Field Work:

I work in SANTULAN which is a mental health
setting. It is a neuropsychiatric specialty hospital which has many departments
which work with organic and functional disorders of brain. SANTULAN has a
psychiatric department that works in the area of knowing the social problems of
individual with mental illnesses and dealing with them. I have also observed
and worked with persons having substance use disorder and the strategies used
in their treatment. I have developed an initial understanding about various
social situations that a person faces during and after mental illness. People
having the problems, as mentioned above, come seeking for treatment and counseling.
Occupational therapy and day care center are also run by my agency in order to
help the people for rehabilitation and employment problems. While working with
agency I collected these data, on the basis of that data I got these findings.
Collecting data was a long process in which I took help from agency supervisor
as well as department supervisor and also analyzed deeply case histories and
prescription data.

REVIEW OF
LITRATURE:

 

Mental illnesses
are quite common. It can happen to anybody sitting here. A popular myth is that
recovery from mental illness is not possible but I would like to clarify that
mental illness is treatable and most of the people with mental illness show
genuine improvement and lead stable lives. Good health of a person can’t be determined
only by healthy body, a healthy person should have a healthy mind also. A
person with a healthy mind should be able to think clearly, should be able to
solve the various problems faced in life, should enjoy good relations with
friends, colleagues at work and family. Mental illnesses are medical conditions
which result in disruption in person’s thinking, mood and ability to relate to
others. Mental illness includes a wide range of health problems. Most people
think mental illness as an illness associated with severe behavioral
disturbances such as violence, agitation and being sexually inappropriate. Such
disturbances are usually associated with severe mental disorders. However, the
vast majority of people with a mental illness behaves and looks no different
from anyone else. These common mental health problems include depression,
anxiety, sexual problems and addiction.

 

Recent studies have demonstrated that a
wide range of adversities, and not just sexual abuse, are predictors of many
forms of mental ill health, and not just PTSD. These adversities have been
found to include: mother’s
ill health, poor nutrition and high stress during pregnancy; being the product
of an unwanted pregnancy; early loss of parents via death or abandonment;
witnessing inter-parental violence; dysfunctional parenting (particularly
‘affectionless over control’); parental substance misuse, mental health
problems and criminal behavior; childhood sexual, physical and emotional abuse;
childhood emotional or physical neglect; bullying; childhood medical illness. There have been
tremendous advances in the understanding of the causes and treatment of mental
illnesses.

Childhood
maltreatment has been linked to a variety of changes in brain structure and
function and stress-responsive neurobiological systems. Epidemiological studies
have documented the impact of childhood maltreatment on health and emotional
well-being. The organization and functional capacity of the human brain depends
upon an extraordinary set and sequence of developmental and environmental
experiences that influence the expression of the genome (Teicher 2000, 2002;
Perry and Pollard 1998). Unfortunately, this elegant sequence is vulnerable to
extreme, repetitive, or abnormal patterns of stress during critical or circumscribed
periods of childhood brain development that can impair, often permanently, the
activity of major neuro regulatory systems, with profound and lasting
neurobehavioral consequences (Teicher 2000). Converging evidence from
neurobiology and epidemiology suggests that early life stress such as abuse and
related adverse experiences cause enduring brain dysfunction that, in turn,
affects health and quality of life throughout the lifespan. An expanding body
of evidence from human research suggests that early stressors cause long term
changes in multiple brain circuits and systems (Sanchez 2001).The amygdala
mediates fear responses, and the prefrontal cortex is involved in mood as well
as emotional and cognitive responses. The hypothalamic-pituitary adrenal (HPA)
axis plays a critical role in the stress response. There is an important
interaction between development and stress, e.g. young infants do not have a
fully developed glucocorticoid (cortisol in humans).Response to stress, and
Substantial research has focused on the relationship between development, early
stress, the HPA axis, and the hippocampus, a stress-sensitive brain region that
plays a critical role in learning and memory.

 

Adverse Childhood
Experiences are an issue of a concern because they are very disabling, they
effect general population on its beginning, and they often lead to a stigma.
Major mental illness that are a result of adverse childhood experiences
consists of Mood disorders, Anxiety, Schizophrenia, Personality Disorders,
Dissociative disorders, Somatoform disorders.

The overall
prevalence of different mental disorders varies according to different
cultures, different countries or we can say from place to place. Mental illness
has also a gender perspective. Various disorders prevail more in life of men
than in women. Overall lifetime prevalence of mental
disorders was found to be 5.03%.Rates among males (5.30%) were higher as
compared to females (4.73%). Among the disorders depression was found to be
highest followed by substance use and panic disorders. (Deswal BS, 2012).

The prevalence rates of different disorders are different
in the country. Like the prevalence rate of schizophrenia on an average varies
from 2 to 3 per 1000. And the prevalence rate for depression varies from 1.5 to
37.74 per 1000 (Vyas & Ahuja, 1999).

 

From the review of literature we
can analyze that mental illness is closely related to childhood problem and it
can be treated and recovery from most of the mental illness is possible. Mental
illness prevails with culture and ethnic differences and different disorders
have gender differences also. 

 

ISSUES CONCERNING MENTAL ILLNESS:

 

There are various issues of
adverse childhood experiences concerning mental illness to which adolescents
and adults are prone:

 

Child Physical-Sexual-Emotional Abuse:

 

A study in The Netherland found, that people who had been abused
as children were nine times more likely than non-abused people to experience
‘pathology-level psychoses. Sexual abuse is a particularly traumatic
violation of an individual. Sexual
abuse has a severe trauma and the trauma faced by both the sexes, men
and women is the same. Victims of
Sexual abuse can develop an increased risk of suicide attempts and of
depression. There is an increased risk for developing PTSD. Boys suffer from
similar mental health disorder symptoms as girls in the aftermath of Sexual abuse and have to negotiate the
same, or potentially greater, negative societal reactions.

And even when I calculated data which I
obtained from my counseling reports I found that most of the people have some
issues in their childhood. Either they said that they don’t want to discuss or
they said they don’t want to recall that.

 

Gender Based Vulnerabilities:

A woman can face social, physical, sexual and emotional
violence (Gupta, 2006). The gender based violence is a risk factor of mental
illness for not only women but also children of that kind of families, and
proves as a catalyst for various mental illnesses. The most commonly faced
disorders in these circumstances are depression and PTSD (Post Traumatic Stress
Disorder). In India women are not given their independent identity that not
only affects them but also other stake holders of the family, especially
children whose cognition is developing.

In a patriarchal state like India, this is a major problem.
Children see a lot of discrimination and exploitation on women and start
developing a kind of stereotypes and prejudices that mold their personality and
behavior. And develop several anxiety and depression related disorders. Most of
the parents having a female child with mental illness are worried about their
marriage and in the confusion that what will happen when they will tell the
groom’s side about the mental illness. The stigma that is attached in people
will work and this will lead to a discord in the family. Many children are
abandoned by their family when they are in their episodes of illness. The
problem that especially the women patients face is about their disease being
genetically transmitted to the patient and this being the reason for them
remaining unmarried.

 

Prenatal Nicotine, Antidepressant Exposure Associated
With Childhood Difficulties

Children whose mothers smoked during pregnancy appear to
have more sleep problems throughout the life, and those whose mothers took a
certain type of antidepressant may be more likely to have some behaviour problems.  When I started gathering information about
prenatal care, socio-demographic and their children’s sleep and behaviour
problems, as well as substance exposure during pregnancy, I found higher levels
of prenatal nicotine exposure predicted more sleep problems, specifically
difficulty falling and staying asleep.

 

Early Childhood Television Exposure Associated With
Academic and Lifestyle Risks

Children who are exposed to longer hours of television viewing
at early age, appear to have more problems in school and poorer health behaviours.
The long-term risks associated with higher levels of early exposure may chart
developmental pathways toward unhealthy dispositions in adolescence. A
population-level understanding of such risks remains essential for promoting
child development.

 

Repetitive
Movements Common in Children with a History of Institutional Care

Stereotypes ‘repetitive,
unchanging movements with no obvious goal or function’ appear common among
children who have a history of early institutional care. Institutional care can
help us to better understand the impact of deprivation on children in many
settings.

 

Stigma and Lack of Awareness:

Stigma is a big problem when it comes to mental illness.
Stigma is related to lack of awareness or one reason for stigma is lack of awareness.
Many people are not aware about mental illnesses and think that mental ill
people are dangerous or violent but the fact is that most of the people with
mental illness are neither dangerous nor violent rather people with psychotic
illness are more frightened, confused and despair than violent. And many people
think that if their children misbehave or fail in school, it is because they
want attention but the reality is that behavior problems can be a result of
emotional or mental problems rather than attention seeking devices. Stigma has
many forms like some people follow the myth that mental illness are caused by
weakness in character but the fact is that mental illness are caused by
biological, psychological and social factors. Many people don’t take their
children to hospitals just from the fear of being labeled as ‘mental’ or
‘crazy’ (Davidson, Topor , Mezzina , Borg , & Marin, 2012). The stigma is
sometimes created by the person’s self as what will people think about me and
my child if they are going to know that we are visiting a psychiatrist or any
mental health professional. There is also stigma attached to them by their
families.

 

Exclusion:

This is an important aspect when we treat a child with
mental illness. There is a feeling of exclusion when we consider a child with
mental illness. In general, having a mental illness is considered different
from physical illness. And it is observed a loss in the number of social
contacts when others found a child with mental illness. (Davidson, Topor,
Mezzina , Borg , & Marin, 2012). The numbers of friends get reduced while
being undergoing the treatment and that creates a barrier for the child to be accepted
with his/her mental illness and come for treatment. The children are locked
into their roles as mental patient. There activities are started being taken
too seriously and only considered a part of illness. There social roles are
detached (if they are willing to do so).

 

 

Health Care Services:

A number of primary care settings focus only on the
physical health of child neglecting their mental health (M, 2007). A lack of psychiatric
medical personnel in rural as well as urban areas with mental health services
of the country is sometimes a hindrance in the way of patients to utilize these
services. The biggest reason for this is lack of privacy, confidentiality and
information about options and services available. Girl child’s higher mental
and physical proneness to illness have been seen as being cause by gender
sensitivity to physical cues and social acceptability of sick roles for girls.
Many children with depression would not receive mental health services because
primary health care providers might be unable to screen, treat or refer. According
to National Mental Health Program, India is faced with acute shortage of
qualified mental health professionals; adversely affecting the implementation
of Community based mental health services. The
total number of psychiatrists could be between 3,500 and 5,000 which translate
to one psychiatrist to 200,000 to 300,000 people. Consequently, the need
for psychiatrists is enormous. The existing training infrastructure produces
about 320 psychiatrists, 50 clinical psychologists and 185 mental health nurses
per year (Royal college of psychiatrists,
2012).These
numbers of mental health professional are not enough to cater the needs of
people with mental illness in a country.

 

Conclusion:

Mental illness potentially affects
everyone. Everyone suffering from mental illness invariably faces stressors,
stigma and exclusion. However, it seems that in a patriarchal society, women
are less likely to receive support if they are suffering from mental illness despite
being given many responsibilities, if any male in the household is the patient
of mental illness. So, girls are more prone to several psychological disorders.
Lack of awareness about mental illness continues to come in the way of seeking
mental health services in a timely manner. Children are much likely to receive
less attention for mental illness as their illness is mostly suppressed in the
form of attention seeking behaviour and they can’t deal with their illness
directly and has to depend on adults for treatment of their illness. At the same
time, inadequate mental health professionals also becomes a barrier in
accessing mental health services for children. Sample of young adults from urban, socio-economically
disadvantaged communities reported high prevalence of adverse childhood
experiences. The public health impact of childhood adversity is evident in the
very strong association between childhood adversity and depressive symptoms,
antisocial behaviour, and drug use during the early transition to adulthood. Epidemiologic studies indicate that children
exposed to early adverse experiences are at increased risk for the development
of depression, anxiety disorders, or both. Persistent sensitization of central
nervous system (CNS) circuits as a consequence of early life stress, which are
integrally involved in the regulation of stress and emotion, may represent the
underlying biological substrate of an increased vulnerability to subsequent
stress as well as to the development of depression and anxiety. Early life
stress induces long-lived hyper activity of corticotrophin releasing factor (CRF) systems as well as alterations in other
neurotransmitter systems, resulting in increased stress responsiveness. Many of
the findings are comparable to findings in adult patients with mood and anxiety
disorders. Emerging evidence from clinical studies suggests that exposure to
early life stress is associated with neurobiological changes in children, which
may underlie the increased risk of Psychopathology. The identification of the
neurobiological substrates of early adverse experience is of paramount
importance for the development of novel treatments for children, adolescents,
and adults. And the impact of
major childhood adversities persists well into adulthood, which indicates the
critical need for prevention and intervention strategies targeting early
adverse experiences and their mental health consequences.