To be honest from a young age I always wanted to be a surgeon which is why I entered the medical faculty. But the very first time I assisted in a surgery I realized I was very bad at this !!! I also didn’t really find it interesting. I was in a state of panic for a while as I thought what have I gotten myself into now as there was so much more of medical school to complete and I didn’t have a clear plan for my future.
Luckily I stuck at it and eventually during the psychiatry appointment I realized I enjoyed talking to people and trying to solve their problems. I also realized that this was a field which complemented my personality so I guess it was partly my passion and partly because I wasn’t good at anything else . I see many young people in the same predicament I was in who are in two minds after entering university and not finding it to be what they thought it would be. What I always tell them is to try and stick with the course and complete it and that in time you will find you true calling.
Not usually . No matter how difficult someone’s problem is there is always a way you can help in some way. It is a nice feeling having people come to you with their problems and maybe there is a degree of selfishness in this. And there is immense satisfaction when you help someone and see them do well. Kind of like how a teacher will feel when their student does well at an exam.
Q. Do you find that you analyse yourself ?
No, my wife does that for me.
Q. Does your career / vocation take a toll on your family life ?
I like to think it helps your family life as you see a lot of family problems in your practice and devise solutions to help these families so in turn it gives you insight as to what mistakes you are making and apply what you preach to yourself. It’s interesting that people tend to have a certain stigmatised view about psychiatrists but what I find from personal experience is that most of my colleagues in psychiatry have very good family lives and children who are doing well.
Q. As a psychiatrist how important is it that people consult one at the earliest signs of depression or any type of mental unrest?
I cannot stress the importance of this and thank you for asking this question. A huge problem in psychiatry across the world and not just in Sri Lanka is the treatment delay due to late presentation to services. In most instances the duration of untreated mental illness is inversely correlated to the severity and prognosis. Even if someone is hesitant to see a psychiatrist initially, a visit to one’s GP and being open about your problems is a good starting point and they can help themselves or refer to a psychiatrist if required.
Q. What needs to be done to educate Sri Lankans about the fact that mental sickness is not something to be ashamed about and can be treated like any other illness?
I believe that the development of mental health services is key towards this. The expenditure on mental health compared to total government expenditure is low in Sri Lanka and needs to be increased. In addition to this a more humane Mental Health Act needs to be implemented which will safeguard the dignity of the mentally ill . A group of hard working psychiatrists are constantly lobbying for these to happen and hopefully things will improve soon. I have personally seen some improvement as when I was a medical student there were only 25 psychiatrists for the whole island and now we have over 150 psychiatrists working in all districts in the country. Most psychiatry clinics are extremely busy and though I agree that there is still some stigma , Sri Lankans are less reluctant to see a psychiatrist than previously.
Q. Addictions are only too common today and with the onset of Covid have become even more manifest. Internet addiction and the resultant abuse, drugs, even food. How does your specialty deal with this ?
As psychiatrists we deal with all types of addiction ranging from type A drug use such as heroin to gaming addictions. With the onset of Covid and online schooling an exponential rise in internet addiction is seen. This is a huge problem amongst our youth and parents are struggling to deal with this. Unfortunately, what we see is that some parents identify the problem too late and when they do see their child spending too much time on their phone they confiscate or ban use of devices. This can lead to disastrous consequences as the child is too dependant on the phone to have it suddenly taken away. A more measured, reward based approach is implemented with a structured time table in which the child gets to use his or her device in a controlled manner. Punishment unfortunately does not work in this instance. So, I would tell all parents to respect that child’s need to use electronic devices as this is a given in this day and age, however they need to be vigilant of increasing use which can be monitored in the time they spend on or on how much data is used, and take early measures to curb use or bring them to a professional in mental health.
Q. There is a general perception that anti depressants dull the brain. Could you comment ?
Once again thank you for asking this question as this is one of the myths or falsehoods that prevent people obtaining necessary treatment. There are two reasons for this belief, one being that the illness of depression slows down the brain and can be difficult to treat at times, also antidepressants take a certain period of time to act. So one might see a patient recently started on antidepressants being slow in their actions and attribute it to the medication when it is actually the illness itself causing this symptom. Another reason for this is that the older medications used in psychiatry had many side effects with drowsiness being prominent. But now there are many different classes of medications and you can match them to the patient so as to cause minimal side effects. In actual fact antidepressants if used correctly activate and energize the brain.
Q. Do you think that Covid has increased mental health issues worldwide ?
This is a well-researched and identified fact. The physical symptoms of Covid are well known but many are unaware that there can be a long Covid syndrome in which the physical symptoms subside but anxiety and depression persist. In addition to this the disruption to work and finances and the social restrictions cause immense stress in the general public among all age groups and social classes. Though these patients need to be identified and treated, the key to improving their condition and to improve the mental health of the population during the time of Covid, is to get everyone vaccinated, adhering to safety guidelines and resuming normal work and social activities.
Q. Over dependence on one’s shrink is a common phenomenon in western societies. How would you address it ?
The threshold to see a psychiatrist in Sri Lanka is much higher than in the west. This might be a bad thing in the case of someone severely ill but also a blessing in disguise if the stress they are facing is situational and support from friends, family or their faith can ease the problem with time. Though our social structure is getting westernized constantly we still hold certain family and faith based values which help us get through difficult times without the aid of a psychiatrist. Also for some unfortunate reason we as a nation seem to be in the midst of some crisis or the other continuously and this in turn makes it’s people more resilient in facing adversity. If you look through social media you will notice we also seem to have a very dark sense of humour and can see the funny side of any predicament which is an interesting but mature coping mechanism. So I don’t think at this moment of time we will have a problem of our population being dependant on mental health professionals.
Q. What would be your advice in order to live a healthy and fulfilling life ?
This is a tough one and I’m afraid there is no generic answer. I believe the key to a truly content life devoid of mental stress is to be true to ones thoughts and act accordingly. In psychological terms “cognitive dissonance” is a term used for when you are acting or doing something against your core belief or value system which in turn causes internal stress. You see many people being forced into these situations not because they are inherently bad but because of life’s pressures and deficient systems which are in place. Also some people tend to lead their life according to what society dictates them to, rather than based on how they actually feel, which in turn leads to poor mental health. So being true to yourself and changing accordingly no matter how difficult it may be is an important cog in the wheel of true happiness.
Pic by Damith Wickramasinghe