Mentally ill woman blamed as witch (Boksi) in Nepali village

Mrs. Sita is 25 year female. Her husband is in Qatar (Gulf country) for job for last three years. She is with father and mother in law, brother and sister in law. Sita is a innocent woman however her family members blames that she is not doing her responsibility at home. On many occasion family members frequently scold her despite she is innocent. She doesn’t communicate her stress to other.  On yesterday evening she developed mental illness. She started to shout and shake her body “I am god”. ‘I am Devi’. I need “black goat” otherwise I will kill your family. She suddenly started to beat her family member.  It was very difficult to control her. Many neighbor and surprised that how it happen. After one hour she became fine. Next day many people blamed her she is a witch. She was beaten by many people and  locked on door. Other believed  she is a sprit. Family member believe that she is witch and to reject her day by day. She started to developed episodic abnormal behavior daily. She was brought the traditional healer (dhami jhakri) but  it was not get better. Finally now she is treating with doctor. She  is diagnosed as conversion disorder (mental illness). She is getting better after treatment.

What is the scientific basis of this disorder? Sita developed huge stress because of uncooperative family member and husband in foreign country. She developed stress which she didn’t express to other. Stress converted to physical symptoms called conversion disorder. On the past it was thought that it was due to sexual cause and called hysteria and now it is wrong and  believed that any types of mental stress can developed this intresting mental disorder and can be easily treated when consult with doctor (psychiatrist).

Conversion disorder is a condition in which you show psychological stress in physical ways. The condition was so named to describe a health problem that starts as a mental or emotional crisis — a scary or stressful incident of some kind — and converts to a physical problem.

In conversion disorder, your leg may become paralyzed after you fall from a horse, even though you weren't physically injured. Conversion disorder signs and symptoms appear with no underlying physical cause, and you can't control them.

Signs and symptoms of conversion disorder typically affect your movement or your senses, such as the ability to walk, swallow, see or hear. Conversion disorder symptoms can be severe, but for most people, they get better within a couple of weeks.

Symptoms

Conversion disorder symptoms usually appear suddenly after a stressful event. Common symptoms can include:

·         Poor coordination or balance

·         Paralysis in an arm or leg

·         Difficulty swallowing or "a lump in the throat"

·         Inability to speak

·         Vision problems, including double vision and blindness

·         Deafness

·         Seizures or convulsions

Other conversion disorder symptoms include:

·         Loss of balance

·         Numbness or loss of the touch sensation

·         Inability to feel pain

·         Hallucinations

·         Difficulty with walking

·         Urinary retention

Causes

Episodes of conversion disorder are nearly always triggered by a stressful event, emotional intra cyclic conflicts. If there is stress collected in unconscious mind, stress converts to physical symptoms. The exact cause of conversion disorder is unknown, but the part of the brain that controls your muscles and senses may be involved. It may be the brain's way of coping with something that seems like a threat.

Risk factors

Conversion disorder risk factors include:

·         Recent significant stress or emotional trauma

·         Being female — women are much more likely to get conversion disorder

·         Being an adolescent or young adult — conversion disorder can occur at any age, but it's most common during adolescence or early adulthood

·         Having a mental health condition, such as mood and anxiety disorders, dissociative disorder and certain personality disorders

·         Having a family member with conversion disorder

·         A history of physical or sexual abuse

·         Financial problems

Complications

·         For most people, symptoms of conversion disorder get better with nothing more than reassurance that they don't have a serious health problem. However, symptoms may get worse over time, or may go away only to return within a year. Seeking treatment as soon as possible after symptoms appear may improve your long-term outlook.

Treatments

For many people, symptoms of conversion disorder get better without treatment, especially after reassurance from the doctor that their symptoms aren't caused by a serious underlying problem.

You may benefit from treatment if you have conversion disorder signs and symptoms that linger or keep coming back, you have severe symptoms, or you have other mental or physical health conditions. Treatment will depend on your particular signs and symptoms and may include:

·         Counseling (psychotherapy). Seeing a psychologist or professional counselor can help treat symptoms of conversion disorder and prevent it from coming back. This can be especially helpful if you have anxiety, depression or other mental health issues.

·         Physical therapy and drugs. Working with a physical therapist may prevent complications of certain symptoms of conversion disorder. For example, regular movement of arms or legs may ward off muscle tightness and weakness if you have paralysis or loss of mobility.

·         Treating related stress and other conditions. Conversion disorder may improve when you get treatment for stress, anxiety or another underlying problem. Your doctor may prescribe anti-anxiety medications, antidepressants or other drugs as part of your treatment plans, depending on your individual health profile.

PREVENTION

·         Conversion disorder is triggered by a reaction to some kind of stress. Stress-relieving activities such as meditation and yoga may help reduce reactions to the events that prompt symptoms of conversion disorder.

·         If you have other mental health conditions, make sure you're getting the right treatment. Treatment may include counseling and medications

                                                              

How Can We Be Mentally Healthy?

·      Don’t do deep thinking.

·      Don’t believe traditional false things like witch, ghost, etc

·      Try to be happy whatever you got but don’t forget to do hard working

·      Take as  a good way for your friends success.

·      Don’t abuse Alcohols & Drugs.

·      Do healthy competition on daily life.

·      Don’t be too moral and don’t expect it from other also.

·      Express your problem to other (ventilations).  

·      Make the environment peace and healthy.

·      Break difficult work into different fraction and try to finish one by one.

                                                                   Dr C P Sedain,Neuropsychiatrist,