Dr Perera provides a historical and contemporary account of mental illness and health. Reviewing the biological basis and triggers, psychological diagnosis and treatment, as well as mental health and religious experience. in this presentation for the Alister Hardy Religious Experience Centre.

1. Mental Illness and Health:
biological, psychological
and spiritual aspects
Dr Mahendra Perera
Consultant Psychiatrist

2. Overview
 Psychiatrists view of Mental Illness
 Beyond biology
 Concept of Mental Health
 Humanistic principles
 The past present and the future

3. I thought the world was mad
The world thought I was mad
They are in the majority
so I’am here

4. Etymology
• Psychiatrist – Pscyche – mind and
iatros – doctor
– Replacing alienist
• Schizophrenia – shattered diaphragm

5. Mental Illness
A state of psychological ill
health
The problem is primarily
related to the brain activity
Final common pathway - neuronal

6. cont.
Clustering of symptoms
Duration
Impact
DSM IV construction

7. Individual vs group experiences

8. Classificatory System
International Classification of
Diseases
ICD - WHO
Diagnostic and Statistical
Manual of Mental Disorders
DSM - APA

9. • Neurotics builds castles in the
air
• Psychotics live in them !
• Psychiatrists collect the rent

11. Some common conditions
 Anxiety States
 Phobia – OCD-
 Mood disorders
 Depression
 Bipolar Disorders
 Psychoses
 Delusional disorders
 Schizophrenias

12. Childhood and Aged Care
 Autism
 Specific reading,
writing problems
 Conduct disorders
 Defiant Disorders
 ADHD
 Dementias
 Delusional disorders
 Organic Syndromes
 Addictions
 PTSD

13. Culture bound syndromes
 Koro
 Amok
 Frigpophobia
 Anorexia nervosa?
 Dhat

14. Physical Illness vs Psychiatric
Infectious Diseases
 Swine Flu
 Tubersulosis
Mental Illness
 Depression
 PTSD

15. Biological Therapies

16. History

17. Obsolete
 Sleep
 Hydrotherapy
 Blood letting and transfusion
 Application of mild electric currents
 Fever therapy
 Insulin therapy

18. Obsolete*
 Opiates
 Hallucinogens
 Herbal remedies
 Chemically induced seizures
* Ministering to Minds Diseased: a history of psychiatric
treatment by W.L. Jones ISBN 0-433-17550-8

19. Medicines
 Barbiturates -1900’s
 Stimulants 1930’s
 Anti-depressants & anti-psychotics -
1950’s
 Benzodiazepines 1950’s
 2nd generation of anti-depressants and anti
psychotics ~ 1990

20.  Mood stabilisers incl. anti epileptics
 Lithium, Epilim, Lamictal
 Stimulants
 Ritalin, Dexamphetamine
 Drugs for Dementia -galantamine
 Anti craving medicines
 Champix, Antabuse

21.  Neuroleptics – Largactil, Zyprexa
 Antidepressants – Amitryptilline, Prozac

22. Others
 Transcranial Magnetic Stimulation(TMS)
 Deep brain stimulation
 Psychosurgery
 Vagal nerve stimulation
 Light therapy

23. Electro Convulsive Therapy
(ECT)

24. Psychological Approaches

25. 2 Rx or not 2 Rx?

26. A medical practitioners duties

27. Rights and Responsibilities
Individual
 Refuse Rx
 ?capacity
 Removal of malady
 when no clear
thought
 Retrospect
Society
 Protection
 Animate & inanimate
 Law
 Local/state
 Federal/country
 Expectations

28. Case vignettes
 Depression
 The man who shot himself, incorrectly
thinking all was lost
 Manic depressive Illness
 Female school teacher in a manic episode
behaves inappropriately and loses her job,
partner etc

29. A model
Learnt
behaviour
PAST
LIVES?
Personality
Environmental
Possession
Inherited
Ill patient

30. Possible explanations
 Past life influences
Many Lives Many Masters – Brian Weiss ISBN: 0-7499-1378-9 (pbk)
Journey of Souls – Michael Newton ISBN 1-56718-485-5 (pbk)
 Possession states
Tovil: exorcism and healing rites – Bruce Kapferer & Georges
Papigny ISBN: 955-8736-06-06

31. Attributions
 Sins
 Karma
 Spirit possession

32. Alternative approaches
 Exorcism + sacrifice
 Incantations
Prayer
Supplication
 Sacrifices
 Alternative remedies

33.  Jesus Christ driving out devils
 Stories from ancient civilisations
 Phenomena of poltergeists
 Intuitions, telepathy and other phenomena

34. Examples
 Schizophrenia/Psychotic depression
Exorcism
 Shaman’s views

35. There are more things in heaven and earth,
Horatio,
Than are dreamt of in your philosophy*
*Hamlet Act 1, scene 5, 159-167

36. Prevention
 An ounce of prevention is worth a pound
of cure
 Are mental illnesses preventable?

37. Health
 A healthy mind in a healthy body
Physical
Mental
Spiritual

39. The past, present
and future: reflections

40. Although the trifling of life
creates differences
In the higher order of things
we are all one
THANK YOU