CHAPTER 1
INTRODUCTION
Family is a small social system made up of individuals related to each other by reason of strong reciprocal affections and loyalties, and compromising a permanent household that persists over years and decades.It is the most significant primary unit of human society. It is the earliest institution of humankind that is mainly depends upon man’s biological and psychological needs. Without family, no other social institution like religion or government can exist. The sustainability of family is vital to the development and progress of the society. The term family has been derived from the Latin word ‘familia’ which means a house hold establishment.It indicates to a number of individuals staying and living together during important phase of their life time and they are bound to each other by biological, social and psychological relationship. It may be the joint family or an individual family in the modern society.
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Famous sociologist M.F Nimkoff defines family ‘as a joint effort of husband and wife either with child or without child’. The existence of family is very significant. Family plays a major role in the society. Family generates human capital resources and also it has the power to influence single individual, each household and the behaviour of the community (Sriram, 1993).Hence family is being studied as the most basic unit in the different branches of social science. Human developments, Psychology, anthropology, economics, social psychiatry, social work are examples. Family is a major resource for the various needs of human beings. It is the family plays a major role in the nourishment of children and meeting their most basic needs such as emotional bonding, health, development and protection.There is enormous potential lies within the family and it proves it during the trouble times by providing stability and support.The growth of an individual and the society mostly depends upon this basic unit of the society. (Desai, 1995a). Culture to culture and society to society, families and family dynamics varies and they cannot be interpreted without the context of cultural factors. Culture determines the roles of family members and it explains families’ ways of defining problem and solving them.
The family in India is known as an ideal homogenous unit with strong coping mechanisms. In a large culturally diverse country like India have plurality of forms in the families that varies with class, ethnicity and individual choices. Collectivism is an important dimension of Indian culture that affects the family functioning. In other words, the basic aspects of human life such as economic, philosophic are given the outlook of interdependence amongst persons. Family cohesion, cooperation, solidarity, and conformity are the major values of collectivistic society like India. Indian joint families are considered Strength, stability, closeness, resilience, and endurance are encouraged in the Indian joint families where family loyalty, family integrity is given priority than individual choices. These unique dimensions of Indian families help the families to overcome difficult situations that they face over the course of time. When an individual in the family is struck with a disease or any other troubles, the entire community helps that individual to face that situation.
What is Family support?
Family support can be defined as the benefits a person receives from the family and friends such as physical emotional and material benefits. Positive social support helps one to improve in the ability to make healthier choices in life. Family or social support would also means being able to access people that a person can rely upon if needed. In an individual’s life, family support is essential at all times. Good support from the family enhances the individual to excel in his or her field of interest. On the contrary, poor support results in poor performance. A person hailing from a lower socio economic strata s considered to be
Mental Health and family support
Health is the most important aspect of human life. According to WHO Health is a state of absolute physical, mental and social well-being and not only the absence of disease(World health Organisation,2001) Mental health is another area where family support is an inevitable factor. In a situation where resources for mental health are scarcely available families form a valuable support system. Mental health is defined as state of well-being in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to contribute to her or his community ( World Health Organisation, WHO includes social support as one of the key determinants of health. Mental illness is medical condition that affects an individual’s thinking, emotions, ability to relate with others and daily functioning. Just as any other physical conditions, mental illness are medical conditions which results in poor capacity for coping with the demands of life.
Mental illness is considered the most pathetic condition of a human life. Indian traditions considered a mentally ill person as an outcast since he or she was labelled as cursed by gods. The presence of mentally ill in a family brings huge implications. There will be only a handful in the family who will be willing to take care of the patient namely the mother or wife. When one person is ill in the family, the entire course of the family gets changed. Because society would label the family as cursed and this would bring a wide range of problems especially if the family hails from a lower social and economic strata.
On the contrary, Indian families are the key resources for the mentally ill. There are mainly two reasons for this position. First, it is mainly because of the traditional practice of collectivism and concern for the relatives in adversities. As a result, most Indian families do not hesitate to be significantly involved in all aspects of care for their relatives. The tradition of involvement of family in the care of mentally ill has always existed. Secondly, since there is a long gap between the need and thus the clinicians mostly depend on the family. Thus having adequate family support becomes the need of the patient, clinician and health administrators.
INVOLVEMENT OF FAMILY IN THE MENTAL HEALTH SERVICES IN INDIA
In the pre independence era, mental health care services in India were not organised. Usually persons with mental illness were taken care by family members or religious institutions. In other cases they roamed free.’ Mental asylums’ were introduced by Britishers where unwanted dangerous mentally ill were kept behind shut doors. Though it was initially for their soldiers, later Indian population also received the services. T was in Bombay in 1745 the first mental asylum was established. The second in Calcutta in 1781, the third in Madras in 1794 and the fourth in Monghyr, Bihar in 1795. Globally there were changes taking place in the mental health scenario, which involved ‘moral treatment’ and comprehensive community mental health approach. However, not all these changes in Europe and America made any impact on the Indian scene. Approach of the Government until 1946 was to establish custodial and no therapeutic centres.
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In 1957, there was a shift in the mental health field when Dr.VidyaSagar the then superintendent of Amritsar Mental Hospital, took initiative to involve the close relatives of the mentally ill in the treatment. The family stayed in the hospital campus along with the patients in open tents. This in fact aided the speedy recovery of the patients in comparison with those patients who did not stay with the families. Christian Medical College,Vellore established family wards in the psychiatric setting which followed many advantages such as accelerated rate of recovery, low relapse rates.
Many family members started helping the community by identifying the psychiatric patients and providing the guidance. The close relatives of the patients were asked to stay with the patients in the open wards .at NIMHANS.Using family as a major resource in the process of recovery of mentally ill has the advantage of relieving the professionals.Community care has been a paradigm shift for psychiatric treatment worldwide.
Recovery in mental health
Recovery in mental health cannot be easily defined. This significant aspect depends upon many factors. A process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential (Samhsa, August 2011). Recovery from mental illness is a long term process. It involves the experience of healing and transformation and by which the person learns to live a purpose oriented life in the society. He or she would learn to make use of his or her potential in the very journey of healing.
Bipolar disorder is a recurrent and long-term mental illness that can seriously affect the lives of patients and their families. Bipolar disorder is a common psychiatric disorder that includes periods of extremely elevated mood and periods of depression and periods of full or partial recovery. The cycles of high and low mood states and well periods may follow an irregular pattern. The treatment of Bipolar disorder cannot be limited to pharmacotherapy alone. Psychotherapy, psycho education, peer group support also play major role in the process of recovery.
Bipolar affective disorder
Bipolar disorder is a chronic, severe illness that can impose significant impairment on multiple aspects of a patient’s life including interpersonal relationships, occupational functioning and financial stability (APA, 2002). Globally it has been ranked the ninth highest cause of years of life lost due to death or disability and the 12th most prevalent cause of disability among individuals aged between 15 and 44 years (World Health Organization, 2004).The distress and impairment caused by bipolar disorder is a wide spread and important issue. Globally the lifetime prevalence of all forms of the illness, often referred to as bipolar spectrum disorders, has been estimated to be 5% in the general population. Ganguli (2000) reported that the national rate of affective disorder in India as 34 per 1000 population.
This disorder significantly affects the functional capacity of the person. Apart from regular medication, support from the near and dear makes a large difference in the recovery process. The practice guideline of The American Psychiatric Association (APA) for Bipolar Disorder treatment suggests the use of certain psychotherapies which includes family therapy as well(American Psychiatric Association,2002) So there are high chances that by the sincere involvement in the care of these patients they may improve in their psychosocial functioning and also to cope with their own struggles due to the illness.
Conclusion
Unlike the institutionalized care, in the community based care for the persons with mental illness, the role of family is very important. The bio medical, socio economic, psycho- spiritual and every integral dimension of the society is necessary in the recovery process. Family being the smallest unit of the society therefore is of much importance in rebuilding the life of the persons with mentally ill. Family is pivotal to catering to the persons with mental illness as they function as the primary care givers. In short, The involvement of family is the need of the hour.
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