NEHRA ET AL./ MENTAL ILLNESS, STIGMA AND KHAP PANCHAYATS
discrimination such as loss of social status and self-esteem, delayed
seeking of treatment and prolonged course of illness, to mention a few (Link, Struening, et al., 2001; Link & Phelan, 2006). Now there are mounting evidences all over the world including India, which have shown clearly that stigma is associated with mental illness (Thara&Srinivasan, 2000; Gureje, Lasebikan, et al., 2005). Stigma is an issue that most people with experience of mental illness and their relatives would recognize, seeing it either in them or in other people. Self-stigma refers to the internalized feeling of guilt, shame, inferiority, and the wish for secrecy experienced by those who live with a mental illness (Goffman, 1963). Courtesy stigma or stigmaby-association namely, the stigma experienced by parents, siblings, spouses, and children of people with mental illness (Goffman, 1963). It is generally believed that stigma arises from internalizing the negative messages and behavior that people with experience of mental illness receive from others. It leads to negative emotional reactions of low self-esteem and self-efficacy and other deleterious effects (Link, 1982; Link, Cullen, Frank, et al., 1987). As a consequence they assume they will be rejected socially and so believe they are not valued (Livingston & Boyd, 2010) and avoids the search of work. Presence of stigmafound to be having profound impact on patients as well as on relatives of sufferers. Hence, destigmatization of psychiatric problems is essential to improve the condition of this vulnerable population. Corrigan &Rusch (2002) argue that the most effective means of combatting self-stigma is by attacking societal stigma (discrimination). So, there is an urgent need to start a genuine attempt to move away from stigma. Understanding and talking about the effect of the stigma is the first step in a journey to bring the change in community's acceptance. In Dr. N.N. Wig's words, we found now gross discrimination against people with mental illness in all spheres of life like job, housing, marriage, immigration etc.; thus greatly reducing the opportunities for mentally ill for their rightful participation in the society. In fact, many people hesitate to get help from mental health professionals for fear of being looked down upon. It is unfortunate that this happens in spite of effective treatment available for psychiatric conditions. They need help, but still face hostility and discrimination at home, at work or in the community. People with mental illness often recover and person become able to work, learn and participate fully in the community. Indeed, the stigma experienced by people with a mental illness can be even more damaging than the symptoms of illness. The effects of stigma are various. Stigma. n Causes feelings of isolation, hopelessness, and low self-esteem. n Creates problems with employment. n Negatively impacts housing. n Causes Harassment. n Causes physical violence. n Negatively impacts community participation. n Reduces resource & opportunity access. n Causes a person to deny the illness. n Causes a person to refuse treatment. n Leads inadequate coverage of mental health treatment by health insurance companies.
Why to involve Khaps in fighting against Stigma?
Mental health services in India are ignored; mental health professionals face huge challenges in working to promote the mental
well-being. The diagnosis of psychiatric illness is considered as
damage to an individual and his family and negative consequences linger for life time. Recovery is not just about remission of symptoms of illness, it should also be used to plan for future holistic growth. There are several factors that will act as determinants in the recovery of individual. It is important to recognize which of these has more substantial effects as well as how the effects on one domain of life impact other domain of people's lives. Stigma is a formidable obstacle in the progress of mental health treatment. The stigma and negative societal views attached to these disorders can make the diagnosis more distressing. The associated stigma with these disorders can devastate the lives of sufferers as well as their caregivers via increasing distress, disability, reduced productivity and lowered quality of life. In general, respondents are fearful of people diagnosed with mental illnesses and desire emotional distance from them. The public attitudes tend to characterize these people as dangerous, unpredictable, unreliable and so on (Jackowska, 2009). Although, there are instances that showed that awareness (e.g. showing intervention films) significantly improved general attitudes to serious mental illness and social distance, with a trend towards reducing perceived danger (Kerby, Calton, et al.,2008). A major impediment in the holistic treatment is social exclusion by the general population (Kingdon et al, 2006). The outcome of educating the public and community involvement creates a significant positive attitudinal change in those with mental illness. The experience of the development of de-stigmatization programs is a complex process that faces several important barriers. Researchers believe that to prevent mental health problems in marginalized and vulnerable groups and to treat mental health problems need immediate attention from the government, policymakers, and civil society organizations (Kumar, 2011).One of the solutions of these problems is to involve the social institutions that have already been deep rooted in the society. Khap is one of the most powerful social forces that determine an individuals' and groups' behavior. The benefits of Khaps collaboration are difficult to ignore. Although, connotation of Khap has, thus, undergone a paradigmatic shift from its reputation of being 'positive decision makers' and being criticized for honor killing involvement (here it is important to remember that Khap Panchayats have always denied their role in honor killing). It has now emerged as a strong mean to social change (e.g. protection of girl child or stop foeticide killing points of view), and can surely develop nationally as a positive force. Involving Khap in mental health promotion will be a significant investment to promote mental health need in community. It will not only help in promoting mental health but also reduce associated stigma that will lead to significant successful recovery from mental illness. A relatively brief educational program and joint team work, will demonstrate that attitudes can be changed.
Khap Panchayats: an overview
When people consider the question 'What is the role of Khap Panchayats', they are usually thinking about what has been recently portrayed bymeans. But there is another way of looking at this question that you should consider for enhancing mental health services for rural India. That is, we should seriously think about what these panchayats are able to do in terms of the rehabilitation of psychiatric patients back into community.Khap panchayats (castecouncils) are community groups usually comprising elderly men