Sunday, June 27, 2010

Are we Helping for their Cause

Diagnoses, Misnomer or Stigmatizing the individuals suffering from Mental Illnesses: Are we helping for their cause or making life more difficult for them? (All of you are invited to give your views)

Since we all are here to reflect your thoughts with our great creative and scientific bent of mind, I would just like to ask all of us a question:

Have you ever heard of a term called "High Functioning Mental Retardation?".
( To those who are not aware of Mental Retardation I would like to explain them that Mental retardation is a developmental disability that is marked by lower-than-normal intelligence and limited daily living skills. Mental retardation is normally present at birth or develops early in life.

And usually mental retardation is more or less genetic and by birth but sometimes it develops in early childhood. Certainly, it is different from mental illness. Mentally retarded could be suffering from mental illness at the same time. But Mentally ill are never categorized as mentally retarded because before the period of the illness they were considered to be “normal” individuals. Moreover, mental illness could be treated with Drugs (Psychotherapeutic medications), counseling and psychotherapy and the person can reach to its premorbid or previous condition when the individual functioned normally but mentally retarded individuals though could enhance its skills with the help of several professionals but could never have a so called “normal” condition or functioning.

After understanding the meaning of the term in my opinion we could not make both the statements together that the individual is both “mentally retarded” and “highly functioning” at the same time. Retarded means “below average” and highly functional means “above average”. How can we keep both the terms together which mean exactly opposite. Are we discovering Oxymoron in science and psychiatry or psychology. I do not know.

I still do not understand what is it and where it has discovered, at least not been described neither in ICD 10 and nor in DSMIV, though I have come across many other high functioning terms like high functioning autism, high functioning aspersers, high functioning schizophrenia and so on but this is the term first used by a trainee psychiatrist in a very prestigious Mental Health Institute and I saw the history and this particular diagnosis on patient which was made five years back. I think one could use his or her common sense before making such a diagnoses.

So it is thought provoking. Just think before making any such diagnoses as it may affect the patient's treatment as well your own career.

With due regards to your sentiments, I would just like to ask you a question then why do we then call it "Mental Retardation" , why cannot we discover of some better term, when you already that the individual is highly functional.

I myself have met few people which are functioning as "highly functional people" like Prof. Ellen Sachs diagnosed as "high functioning Schizophrenia " and the author of her book "The Center Cannot Hold: My Journey Through Madness" and I have seen a girl from Delhi, who was highly scholastic and scored almost 99% marks in her every class till then and very good in her knowledge in writing but rarely she used to speak her feelings to her mother even with whom she had the best comfort level as she had been diagnosed as "High functioning Autism".

My understanding is that these people are called as "High functioning" , because they are mentally ill but at the same time they could escape the disabilities in intellectual and cognitive functioning because many of the people with such kind of illnesses could become somewhat dysfunctional but few remain as functional as they were earlier or even emerge out to be a much more mentally healthy and highly intellectual and cognitively functional than they were earlier because of they are no longer imbalance in their neuro-chemicals released in the brain.

I know that this would help in prognosis of any plan if the person is highly functional. But I would like express my views in the following manner:

The child I have seen the diagnoses as "High functioning MR", (after which I raised this issue) has been changed the diagnosis at other places as well and all other mental professionals negated the diagnoses of "Mental Retardation" itself, except the first diagnoses which was made at this prestigious institute. (I would not like to name the institute at any cost as being one of the very good institutes of Mental Health in India, that may create a bias amongst the professionals and my debate is not against any institution it is just against the "term", which has been discovered recently, but I certainly could not see any logical explanation in its favor and nor any such research articles). Happening to be somebody related to me somehow he tried to clarify his doubts about the diagnoses. Also, it is sad that after that he changed the name of his son because after confirmations of several other highly qualified professionals he could not digest the "term Mentally Retarded". I raised this issue because when his parents tried to get admission in some good school and being honest they went with all his medical reports from that institute, he was denied admission in that particular school and asked to take him to a school which is meant for mentally retarded. Later he went to another school with a changed name and he is excelling in studies has a very good inquisitiveness for mobile and computer technology. You can't imagine he could do things himself which I and you can't even imagine at merely 8 years of age. He could play very high intellectual games like "Soduku" and more over he is so inquisitive that he would even ask you the highly philosophical but logical and intelligent questions "like what are the parts used in laptop", "how it has been developed" and "how the internet connectivity functions”-seeing my husband working on the laptop. These questions are very normal for today's kids , but this raised a kind of alarm in me about the particular diagnoses and so I raised that question. Now, my question to all the professional is that Should anyone still call the individual as Mentally Retarded?"

Though , few people and few institutes claim that it already have some kind of diluted diagnoses for them, but at the same time can we brainstorm and find out some other more mankind friendly term especially for kids like the stated above. They also claim to be friendly in person’s treatment and management, but did it really help the individual?
Still I would just say that my aim is also to improve the treatment and make it more effective to the suffering individual by making it more friendly in the growth of that person and as less stigmatic as it could be.

May be now we could think of even redefining the term "Patients" as such because that again labels them of belonging to some abnormal category, rather we could call them as " Individuals currently suffering from this disease"

But at the same time I would say that I am against calling any person as "Mentally Retarded", when we all know that individual is highly functional.

At the end my request to all Mental Health Professionals is that "Can't we find more human friendly terms for such kind of individuals?”

At the same time this would not change in a day or two but if we start brainstorming now it would still take few years to reach a conclusion which becomes a standard practice or accepted as a standard term at least when taught in the Mental Health Courses or published in Journals, reports etc.

May be some day we could join hands together to find a solution for "terminology" problem and reduce stigma and biases of the society which goes against their healthy coping and growth after recovering from their illnesses.
You and me as mental health professionals could understand the meaning of diagnoses as being trained in those professions but what about those people who are not at all informed about the diagnoses we make or very little informed.
I know we need to educate the masses also but at the same time we need to be having more "social friendly" terms while making such kind of diagnoses.

I am happy that some people are passionate enough and have urge to help such kind of individuals by what they call as diluting the diagnoses but actually we did not help this individual and this is an example, that before , many more people like the individual stated above would be denied from mainstream education for the simple reason as stated above, we need to correct ourselves.

I would invite many others to have their views with their logical and professional experience for or against my views.

Also, I would like to question many other diagnoses which are not in favor of the suffering individual.

Dr Smita Pandey Bhat
Clinical Psychologist
Gurgaon, Delhi - NCR, INDIA

Email :

Url :