29.3.

10 Phencyclidine (PCP)
PCP is a synthetic chemical that may
cause disorientation and hallucinations and
make the user feel dissociated from the environment.
Users sometimes develop a severe

be difficult to reverse.
depression or a severe psychotic state that may

29.4 Epidemiology
11.3 percent of all
of a year between 9.5 and
Survey suggests that over the
course
However not even
substance related disorder.
aduts, more than a crore people display
Alcohol and nicotine found in cigarettes are legally
20 percent of them received treatment. substances
use some of the other illegal
available to all adults. Nearly 13 percent of people

29.5 Etiology
abuse and dependence have been put
A variety of explanations for substance
forward.
who turn to substance.abuse have
The psychodynamic view propases that people
inordinate dependency needs traceable to the oral stage of life.

The leading behavioral view proposes that drug use is initially reinforced because
it reduces tension and raises spirits.
The biological view is supported by studies of twins and adoptees which suggest
that people may inherit a predisposition to substance dependence. Biological researchers
have further learned that drug tolerance and withdrawal symptoms may be related to the
brain's reduced production of particular neurotransmitters during excessive and chronic
drug use.

The sociocultural view proposes that the people most likely to develop a pattern of
drug abuse are those living.in socioeconomic conditions conducive to stress or whose
families value or tolerate drug taking.

29.6 Course and prognosis

The course of dependence, abuse, intoxication and withdrawal varies with the
class of substance, route of administration and other factors. Intoxication usually develops
within minutes to hours after a large single dose and continues with frequently repeated
doses. The course may be relatively brief in some substances and in sóme it is chronic,
lasting for years.

Substance dependence is sometimes associated with spontaneous, long term

remissions. During the first 12 months after onset of the remission the individual is
particularly vulnerable to having a relapse. Many individuals underestimate their
vulnerability to developing a patfern of dependency. The presence of co-occurring
disorders often increases the risk of complications and menta
a poor outcome.

170
29.7 Therapy
Therapy for substance abuse and
its cause. Often several
dependence vary as widely as explanations ror
approaches are combined. A common behavioral technique is
aversion therapy, in which an
unpleasant stimulus is paired with the drug that the person
is taking.

A widely used behavioural treatment for substance related disorders is aversion

therapy, the approach based on the principles of classical conditioning. Here individuals
are repeatedly presented with unpleasant stimulus at the same time that they are
an
taking a drug. After repeated pairings, the individuals are expected to start reacting
negatively to the substance itself and to lose their craving for it.
For example, Aversion therapy has been applied to alcohol abuse and
dependence
more than to other substance-use disorders. In one
technique, drinking behavior is paired
with drug-induced nausea and vomiting. In another procedure people with alcoholism
were askedto imagine extremely upsetting, repulsive, or frightening scenes while they
are drinking. The supposition is that the pairing of these imagined scenes with liquor will
elicit negative responses to liquoritself. One of the major problems with these approaches
is that they can be successful only when subjcts are sufficiently motivated to continue
with them despite their unpleasantness or demands. In fact, behavioral treatmènts generally
work best in combination with cognitive approaches
Insight therapists try to help people with substance related disorders become aware
of and address the psychological factors that contribute to their pattern of drug use
Psychodynamic therapists, for example, first help clients uncover and resolve their
underlying conflicts and then try to help them change their substance-related styles of
iving. Client-centered therapists guide clients to accept the feelings and thoughts that,
according to their theory they have hidden from themselves while turning to drugs.
Cognitive and behavioral techniques have been combined in such forms as
behavioral self control training (BSCT) and relapse-prevention training. Biological
treatments include detoxification, antagonist drugs, and drug maintenance therapy. Socio-
cultural therapies treat substance-related disorders in a social context. The leading
approaches are self-help groups, such as Alcoholics Anonymous, culture-sensitive
treatments and community prevention programs.

29.8 Key Terms

Substance related disorders Intoxication

Alcohol-Related Disorders Nicotine

nhalants Phencyclidine
Cocaine Opioids
Cannabis

171
29.9 Self-Assessment Questions
different types of it? [29.1;
are substance related
disorders? Describe the
7. What
29.21
relatd disorders? [29.3.n]
substance
..8. What are the clinical features of disorders.
for substance related
the etiology and treatment procedures
9.ldentify
[29.5; 29.71
Additional readings
Substance use disorder: Abuse, dependence and
Widiger, TA., & Smith, G.T. (1994).
dyscontrol. Addiction, 89,267-282.

*****
 Lesson No. 30
PSYCHOPATHOLOGY IN INDIA

30.0 Objectives
in
1. To familiarize the 'stüdent with ancient perspectives on psychopathology
9
India
in
student to' contemporary research on psychopathology
2 To introduce the
India

30.1 Introduction
reported from ancient
As inother countries, psychopathological behaviour has been
known to exist from the third century
times in India too. Therapeutic practices have been
prevalence of
striking feature of such behaviour in our country is the widespread
B.C. A
superstitious beliefs regarding causes and manifestations
of mental disorders evenin
mental illness including treatment
current times. This chapter wil cover conceptions of
research on the pattern
appróaches in ancient times and
the contemporary epidemiological
disorders.
and prevalence of mental

30.2 Ancient sources

ancient scriptures, the Atharvaveda isprincipal source in the Vedas

the
Ofthe compilation of all
reference to mental disorders and their treatment. A systematic
that has
main features of this are the following
the yiews carried out by 200 A.D. The
was
with therapeutic approaches hav been
Twenty types of mental disorders.
described. The disorders were categorized into
severe and mild.disorders
and personality. impairment:
Zone of origin, prognosis,
The disorders are classified based on aetiology. :

and intensity.
said to. consist of three gunas namely, rajas or the
Human personality was
and enjoyment; tamas or the impulse
expansive impulse indicating pleasure
evil;,and satva or the pure and true.
of destruction and
simply sum
not a total of all the gunas
Human personality was censidered
are combined. to give thè individual a
distinct
but the way in which they
individuality.
was
three gunas sald to lead to normality while corruntian
The ecuilibrium of the
ard tamas give rise to mental disorders
or doshas of rajas
173
 The therapies suggested are: Atharvani or manasa chiktsa (psychotherapy)
medicines,) and Angirasi (endocrine
Daivya (naturopathy); Anushyaja (herbal
therapy)
used for psychogenic disorders and employed
Psychotherapy was
(self-determination or auto
psychological techniques such as sankalp
the
suggestion); sadesh (directive therapy) paushtikarni (strengthening
and ritualistic therapy (drama and
ego); samvashikaran (hypnosis);
demonstration)
While the objective of psychotherapy was to secure the soundest degree of
mental health that is possible.

30.2.1 Ayurveda
Another ancient source is Ayurveda or the science of life that is said to blend
medicinal, psychological and spiritual modes of treatment of illness and promotion of
health. One of its basic concepts is that the body consists of three humours: vat (gases),
pitt (acide) and kaph (phlegm) and an imbalance in these humours leads to most health
problems. Ayurveda accepts the powerful influence of emotions on the body and
recommends positive thinking as essential for recovery.

30.2.2 Raja Yoga of Patanjali

Another school of thought predominantly based on psychological processes

developed in ancient times was the work of Patanjali called Raja yoga, This was a well
known treatise on total health inclusive of physical, mental and transcendental aspects. It
prescribes eight different stages that are used for modifying afflicted behaviour and for
promoting mental heath apart from achieving higher states of consciousness.
30.3 The contemporary context

One of the earliest epidemiological

studies was done by Surya in 1964 in
Pondicherry. Till then it was believed that the prevalence of mental disorders in India
would be low in
comparison to western countries because of the oriental philosophy of life
with itsemphasis on detachment and a relatively unhurried pace of life, and limited
urbanization and industrialization. It however found both in Surya's study and in
was
subsequent investigations that prevalence rates of mental
to those in western countries.
disorders were almost similar
Epidemiological surveys have been conducted in urban
and rural, and north and south
Indian communities. Studies have shown prevalence rates
ranging from 23 per thousand to 370 per thousand being affected by mental illness. The
average prevalence rate has been found to be about
men being 10 per cent and in
11 percent with the average rate in
women being 15 per cent
Some of the other
findings of
epidemiological research are as iows
The prevalence rates
of schizophrenia are almost the same as in developed
countries.of the west.
174
 .

The variation in pattern however shows that affective symptoms (depression) are
more in developed countries whereas. cognitive symptoms (delusions,
hallucinations) are seen more in India and other developing countries

Higher rates of recovery from mental illness have been reported. in India in

comparison to developed countries

as
The general symptoms of degrees of illness in India have been summarized

follows:
o Rarity of expressed depressed mood
o Higher frequency of agitation than withdrawal

Predominance of hypochondriacal and paranoid features

o Significant presence of somatic symptoms
Infrequency of ideas of sin and guilt

Onset of severe mental disorders earlier in males

o Greater tolerance for mental disorders
o Personality disorders rarely identified as deviant

and familial support for, conditions such as simple

O Greater community
schizophrenia

30.4 Key Terms

Vedas Atharvaveda

Gunas Rajas
Sattva
Tamas
'
Doshas Atharvani
Manasa chiktsa Daivya
Anushyaja Agnirasi
Sadesh
Sankalp
Samvashikaran
Paushtikarni
Pitt
Vat
Kaph Raja yoga
Patanjali

175
30.5 Self-Assessment Questions
1. Discuss the various mental disorders and treatmentas mentionedin Atharvaveda.

[30.2]
2. What is the concept of Ayurveda? [30.2.1]
3. What do the epidemiological studies conducted in India indicate ? [30.3

Additional Readings
Balodhi, J.P. (1986). Perspective of Rajayoga in its application to mental health. NIMHANS
Journal, 4, 133-138.

Davar, B.V (1999). Mental health of Indian women. New Delhi: Sage Publications.
Rao, V. (1989). Psychiatry of old age in ndia.

176