Issue link: https://maltatoday.uberflip.com/i/1055420
16 maltatoday | SUNDAY • 25 NOVEMBER 2018 INTERVIEW Awareness of mental health issues has undeniably increased over the years. More people (or families) are seeking help for conditions such as depression, bipolar disorder, ADHD, etc., than ever before. At the risk of a facile question: does this reflect an actual increase in the incidence of mental disorders? Are more people developing mental conditions… or were we always prone to the same issues, but never recognised them as 'health concerns' in the past? Nigel Camilleri: There isn't a straightforward answer. I think we are becoming a lot more aware of mental health disor- ders; but there has also been an increased level of stress in our lifestyle. There are a number of studies linking life in an urban area – and Malta can be con- sidered urban – to increased stress levels. And according to the stress vulnerability model, the more stress you are exposed to, the greater the chance of de- veloping illnesses such as psy- chosis. There are also societal issues: you mentioned ADHD, for example. A hundred years ago, if there was a boy in class who was very hyperactive, the teacher would send him out in- to the fields to run around a bit, and calm down. Or he wouldn't go to school at all, and would do physical work instead. There was never any talk of 'medical issues', still less 'seeing a psy- chiatrist'… Sasha Taylor-East: Another consideration is that there has been an increase in general expectations. People tend to compare themselves to other people these days: especially on the social media. This may create a certain pressure to live up to 'what we should be like', or 'how we should be feeling'; inevitably, there will be a differ- ence between people's realities, and what they might be seeing around them. That may add to stress and anxiety... Speaking of social media: another effect is that people now 'socialise' 24 hours a day… where, in the recent past, social interaction was limited to specific occasions here and there. Does this constant exposure to other people also have an effect? STE: This is something I was discussing with a schoolteach- er quite recently. Take online bullying, for example: where before, bullying used to take place only at school, nowadays children can't escape from it just by 'going home'. Bullying continues to take place on their tablets, and on their computers. But it's not just about bullying or children. In general, the idea of 'taking a rest' – giving your- self a breather, spending time alone to recharge your batter- ies, and so on – is something we might not be doing enough anymore. It may partly be the pace of modern life, which doesn't allow as much time for oneself… At the same time, greater awareness has also brought about a certain level of scepticism. Sticking to the example of ADHD: some among the older generation might look at that, and say: 'in our days, we used to call them 'naughty kids'." Is it possible that they might have a point… that medical science tends to over-pathologise certain issues? NC: One of the issues we touched upon in our report concerns standards for the as- sessment of mental health in Malta. There are a number of psychiatrists/psychologists trained in different ways, and assessments are carried out differently. As a result, inter- pretations of the diagnosis may vary. So yes, I think there is an element where we may be over- pathologising, in certain cases. However, this is not to say that the conditions don't exist… STE: In fact, by over-patholo- gising certain cases, we run the risk of minimising the severity of what it truly means to have ADHD. Because ADHD is a real condition; and there is a lot of pain and suffering that goes with it. It's not just about a child being hyperactive… NC: One other important consideration is that the reason why conditions such as ADHD – or schizophrenia, or psycho- sis – still exist, is because there is a genetic component which has survived. Genes gener- ally survive because there is an evolutionary benefit to hav- ing those genes. If you go back to hunter-gatherer societies: someone with ADHD, back then, would probably have been an extremely successful hunter, because he was impulsive; had a lot of energy; he would go out there, survive, kill, and get the kill back. It's the same with psychosis: the psychotic person who didn't trust anyone, and stayed in the cave… he or she had a higher survival chance. So this is not something we have invented nowadays. His- torically, these conditions have always existed… Would you say the reason they are now considered problematic, is that there is no longer any benefit to having those conditions… because our lifestyle has changed, perhaps, and the survival modalities are different? NC: Not necessarily. There are still certain benefits to cer- tain conditions. People with autism, for instance, tend to be highly focused on one area of interest: today, they might be- come the next Steve Jobs. Like- wise, people with ADHD tend to be highly creative. So there are 'positives'… but naturally, this has to be balanced with the 'negatives': the suffering associated with the same con- ditions. Nonetheless, I believe we should also look at the posi- tives. Children or adults with ADHD can lead ordinary, pro- ductive lives… if given some- thing they are interested in. It's the same for bipolar disorder: people in a hypo-manic, or mild hypo-manic phase, have been known to create great works of art, or composed great pieces of music. Again, however, the illness does come with a lot of suffering. It would be a mistake to minimise the seriousness of such conditions, but I do be- lieve we also need to be aware of the full complexity of mental health issues… Could another reason for the increased awareness be that the social stigma traditionally associated with mental illness has lessened, leading to more people stepping forward for treatment? STE: Definitely, there has been a movement to talk about mental illness more. Not just in Malta; I think this is an ar- ea where we are feeding off The Malta Association of Psychiatry has just issued a report identifying numerous serious shortcomings in Malta's national mental healthcare sector. Psychiatrists NIGEL CAMILLERI and SASHA TAYLOR-EAST highlight the urgent need to overhaul our general approach to mental health issues Raphael Vassallo Raphael Vassallo rvassallo@mediatoday.com.mt Mental health: The 'Cinderella' of medicine