It's not your imagination: things you must know about anxiety, depression and other emotional disorders that affect one in every three individuals

BOOK REVIEW

It's not your imagination – Things you must know about anxiety, depression and other emotional disorders that affect one in every three individuals

Alexandre Andrade Loch

Psychiatrist at the University of São Paulo (USP), coordinator of the Psychoses Outpatient Service of LIM-27, Institute of Psychiatry, FMUSP. \Majoring in philosophy at the Faculty of Philosophy, Letters and Humanities, USP, São Paulo, SP, Brazil

^{Correspondence}

Authors: Naiara Magalhães, José Alberto de Camargo

Belo Horizonte: Editora Gutenberg, 2012

When we seek to know more about the history of psychiatry and mental illness, we find at our disposal an eclectic set of readings: from the wise and deeply scientifically grounded book of Edward Shorter, the History of Psychiatry¹, to the fantastic philosophical and archival development of Foucault with his History of Madness². Despite the wide variety of speeches and opinions that these readings display, all of them strongly agree on one point: the stigma of mental illness has existed since time immemorial, long before the birth of the discipline psychiatry.

One might mistakenly think that the issue of prejudice against mental disorders and against their bearers is a thing of the past, an issue of the Middle Ages, time of the famous witches hunt. Today, after nearly two hundred years of the existence of psychiatry and with so many discoveries about the brain, provided by neurosciences, the persistence of this sort of discrimination would be incompatible, once it derives from an archaic era. Nevertheless, this is a mistaken idea.

If we look at the international literature on the stigma of mental illness, we can observe that every year increasingly more works are published from all over the world on the issue³. The Revista de Psiquiatria Clínica itself recently showed results from the first national study in Brazil about stigma⁴. In the current days it is clear, for example, that stigma causes immense losses to people with mental disorders: years of delay between onset of the disease and diagnosis, refusal to seek help to avoid discrimination, lack of treatment resources in the public health system and so on⁵.

Once stigma is still present, persisting nowadays and being highly prejudicial, how do we fight it?

Information. This is one of the most important tools in this fight. And information needs to be accurate, scientifically based and accessible to persons who have no technical knowledge about mental health issues^{6, 7}.

The authors Naiara Magalhães and José Alberto de Camargo managed to achieve this goal uniquely with the work It's not your imagination (Não é coisa da sua cabeça).

The opening chapter is one of the most robust and conceptually polished. "To begin with" ("Para começo de conversa") begins with a description of the situation of social invisibility of a person with mental disorder, a situation in which many people are. Figures are high and impressive: people live on average 13 years with depression before seeking treatment for the first time. At another point in the book figures rise to impressive 36 years when it comes about phobias. The authors point out the lack of information and stigma as important causes for this harm to persons. Through interviews with renowned professionals in the area of mental health in Brazil, authors then explain with stunning clarity how mental illness would be the result of social and biographical injuries allied to a "biochemically fertile soil", the vulnerable brain. At the end of the chapter the book's goals are stated: to clarify the tortuous paths by which our mind functions and to provide a "more peaceful coexistence with the diseases of the soul".

Chapter 2 follows the same line of explanation, exhibiting in a very simple and accessible manner the outlines of psychiatric epidemiology, discussing the main risk factors for the development of mental disorders.

Chapters 3 to 8 discuss the various mental disorders: depression, anxiety, pathological use of alcohol and other drugs, bipolar disorder, schizophrenia and Alzheimer's disease. All of them are full of opinions, recommendations and descriptions of the leading specialists in each area in the country. The chapters bring compelling stories of psychological distress; for the mental health professionals the impression is of someone describing a clinical case for discussion. For the lay reader the impression is of familiarity, as if the description would remember him/her of someone he/she knows. Clinical cases bear a richness of details, and are often poignant: likewise the one of an engineer with depression who hid his medical condition for years from his family in order not to disclose weakness; now, after treatment, he was keen to have his name revealed in the book. And the report of Mauricio, who is being sued by the state as a consequence of acts taken because of his obsessive-compulsive disorder; he is required you to pay R $ 1,400,000.00 as compensation for losses to the public patrimony. And the report of the insidious and painful psychosis process of Elisa, which culminated in a hospital admission and in several losses in her life. Finally most of the chapters present self-assessment screening tools for tracking the disorder treated at that session.

Chapter 9 brings great recommendations for the relatives of individuals with mental illness on how the family can help them. Just to exemplify these excellent suggestions, authors suggest that families banish the feelings of guilt that usually accompany the onset of mental illness in the beloved family member, and to adjust expectations more realistically, two issues that health professionals often encounter the management of these families.

In the fore last part of the book public mental healthcare is addressed. Among other things the so-called organizational stigma is discussed: lack of resources, disruption of services, lack of assistance of individuals.

Finally, "Better be safe than sorry" ("Melhor prevenir que remediar") closes the work with key suggestions for the prevention of psychiatric disorders: lifestyle habits that help to maintain a healthy mind, and tips on how to help prevent their children to have experiences that may become fertile fields for the development of mental disorders.

Summarizing, the book Naiara Magalhães and José Alberto de Camargo is a fundamental contribution to the public awareness of the manifestations of mental disorders and the need to treat them. It is an invaluable information tool, which aims to demystify mental illness for the layman and possibly urge them to seek help if necessary. It is also essential in the fight against the stigma of mental illness and to inform the public and break the taboo of having a mental disorder. After all, if you actually are in psychological distress, "it is not your imagination".

Received: 1/9/2013

Accepted: 1/10/2013

• 1. Shorter E. A History of Psychiatry from the era of the asylum to the age of Prozac. New York: John Wiley & Sons; 1997.
• 2. Foucault M. A história da loucura na Idade Clássica. São Paulo: Perspectiva; 1997.
• 3. Schomerus G, Schwahn C, Holzinger A, Corrigan PW, Grabe HJ, Carta MG, et al. Evolution of public attitudes about mental illness: a systematic review and meta-analysis. Acta Psychiatr Scand. 2012;125(6):440-52.
• 4. Loch AA, Hengartner MP, Guarniero FB, Lawson FL, Wang YP, Gattaz WF, et al. O estigma atribuído pelos psiquiatras aos indivíduos com esquizofrenia. Rev Psiq Clín. 2011;38(5):173-7.
• 5. Rüsch N, Angermeyer M, Corrigan PW. Mental illness stigma: concepts, consequences, and initiatives to reduce stigma. Eur Psychiatry. 2005;20(8):529-39.
• 6. Guarniero FB, Bellinghini RH, Gattaz WF. O estigma da esquizofrenia na mídia: um levantamento de notícias publicadas em veículos brasileiros de grande circulação. Rev Psiq Clín. 2012;39(3):80-4.
• 7. Loch AA, Hengartner MP, Guarniero FB, Lawson FL, Wang YP, Gattaz WF, et al. The more information, the more stigma towards schizophrenia: Brazilian general population and psychiatrists compared. Psychiatry Res. 2013;205(3):185-91.

Publication Dates

• Publication in this collection
  02 July 2013
• Date of issue
  2013