Dr Manju Antil (Counselling Psychologist and Psychotherapist)

Believe it or not, animals always lie because deception is often essential for survival. That is why various insects and reptiles, such as chameleons, change colour or shape to blend into their environment and hopefully be passed over by a predator.

When a squid encounters a predator, it immediately ejects a cloud of ink between itself and the predator. This ink cloud is the same colour and shape as the squid. If all goes well, the predator becomes confused, and the squid scoots away unharmed. When you see a frightened animal with its fur raised, it too is attempting to save its own life. Puffing out its fur gives the illusion that it is more significant than it is. Many mammals do this to ward off potential predators.

Chimpanzees, our closest genetic ancestors in the animal world, always deceive one another. When they are nervous, they will grin widely. When a rival adult male approaches, however, and they do not want him to know they are nervous or in a weaker position, they will often turn away and use their hands to close their lips. They will literally “wipe the grin off their face” to not be attacked. As a result, the other chimpanzee will walk away or go about its business instead of attacking the erstwhile smiling animal, which would have been perceived as weaker and more vulnerable. Chimpanzees have also been known to deceive humans. At a zoo in Sweden, a chimpanzee was fooling zoo visitors by appearing docile and munching on the apple she held in her hand. However, in reality, the chimpanzee hid rocks in her other hand because she wanted to assault any visitors close to her enclosure, which she did several times.

According to animal researcher Maxine Morris, elephants have shown deceptive behaviour toward one another. In observing elephants at the Washington Park Zoo, Morris found that those who quickly ate their allotted bundle of hay during feeding time could often sidle up to the slower eating elephants as they (the fast elephants) swung their trunks aimlessly from side to side, a friendly social gesture. However, their real aim was not to get chummy. They would do this until they were close enough to the other elephant to quickly grab some of its uneaten hay for themselves to eat.

Other mammals have been shown to lie and deceive humans. Take the highly intelligent dolphin. Trainers at the Institute for Marine Mammals Studies taught dolphins to remove trash from the pools by rewarding them with a fish for every haul of trash they brought. Nevertheless, one female dolphin decided she would not bring up all the trash just for one lousy fish. She wanted a lot more fish for her work. So she engaged in some sneaky deception by hiding the trash under a rock at the bottom of the pool. She then brought up the trash and gave it to the trainer one small piece at a time so that she could get a fish with each tiny trash retrieval, thereby increasing the number of fish she received. In essence, she lied to be better compensated for her work.

Koko also demonstrated a thorough knowledge of lying when she played chase with one of her male trainers and gave him a small bite. When asked what she did, she instantly volunteered in sign language, “Not teeth.” She not only lied and denied she had used her teeth or even bit the trainer, but she gave away additional information about which she had not yet been confronted. When humans give added, unasked-for information, it is often a signal of deception. The same applies to gorillas! When Koko’s handler confronted her, saying, “Koko, you lied!” a contrite Koko admitted in sign language that she was “bad” and did indeed bite. According to her trainers, Koko’s motivation to lie was to avoid punishment.

Annabella also lies to get something she wants, like going outside. She knows how to ring bells attached to the front door to alert the owner to take her out to relieve herself. Whenever she rings the bells, I diligently take her out. However, sometimes she rings the bells to go potty, even though she just went potty moments earlier. She does not have to go potty; she wants to go out again, to play and have fun.

 THE INFANT LIAR

Jane would hurriedly dash into the room whenever she heard her three-month-old infant daughter, Amy, crying. Amy cried to let Jane know something was wrong—that she needed to be changed or fed, was too hot or cold, or upset her tummy. Nevertheless, as soon as little Amy turned six months old, Jane began to notice that infant Amy was manipulating her. Jane now observed that Amy’s cries were different than they were before. Amy’s new cry sounded fake because it immediately stopped as soon as Jane entered the room. At six months old, Amy had figured out that all she had to do was let out a cry, and mommy Jane would come running to give her attention whenever she wanted it.

Until recently, most researchers and psychologists believed that children were incapable of lying until they were around four years of age because of the complexity of language and brain development. However, recent studies have revealed that this is not the case. Researchers such as Dr. Vasudevi Reddy of the University of Portsmouth in the United Kingdom have shown that human infants can display signals of deception as young as six months of age, when they quickly learn that engaging in fake crying (pausing until they hear someone responding to them before letting out another cry) and even pretend laughing get them the attention they want.

Dr Reddy’s studies showed that infants cry and laugh at eight months of age to distract a parent’s attention, just as my beloved puppy, Annabella, has been doing since she was three months old. Dr Reddy’s research has also shown that infants lie by pretending to be in pain or injured to gain attention. Cassie, for example, tried to grab a stuffed animal in her crib and fell over as she reached for it. She had fallen over numerous times when going for toys in her crib and never cried. She did not cry until she looked up and observed her mother watching her. Immediately, she began to wail as though she were injured. As soon as mommy picked her up, the “crying” immediately stopped. An infant’s motivation to lie is in her attempt to control the world around her and ensure she gets the attention and comfort she needs.

TODDLER LIARS

As gorilla Koko’s researchers observed, the more Koko’s vocabulary grew, the more tools Koko had to lie. The same is true for toddlers. As toddlers rapidly increase their receptive and expressive communication skills, they have more tools to engage in deceptive behaviour. Toddler Kirsty’s mother placed a cake on the table. She turned her back for only a few seconds to get a knife to cut the cake, return to the table and find a chunk of the cake missing. When she looked across the room, she saw Kirsty with frosting smeared all over her face and little hands. She immediately asked Kirsty if she had eaten the cake, to which Kirsty quickly shook her head and replied, “No,” all the while continuing to avert her eyes from her mother’s gaze.

The evidence was all over her face and hands; Kirsty was lying. Perhaps her mother’s tone of voice alerted her to the fact that she was about to be punished. If so, toddlers like Kirsty lie to avoid punishment. When little Kirsty realized her mother did not believe her response, Kirsty embellished her lie and said, “Mickey eat cake.” Mickey was the family parakeet locked in his cage at the time of the incident. So Kirsty not only lied about eating the cake, but she lied by blaming it on an innocent bystander, the bird. The example of Kirsty illustrates that toddlers may not only lie to avoid punishment but may also lie to make themselves look good.

As we have seen with infants, toddlers may lie to gain attention and reassurance. Little Ryan was not too steady on his feet. He took a spill trying to get from point A to point B and fell flat on his behind. Initially, he did not cry and was ready to pick himself up until he looked back and saw that his dad was watching. He immediately let out a howl as though he were in excruciating pain. As soon as dad came to the rescue, kissed him, and picked him up, Ryan immediately stopped crying and began laughing hysterically. He knew exactly what he was doing! He just wanted a little of dad’s love and attention, and when he got it, he was tickled—hence, his joyous and self-satisfied laugh.

Toddlers may also lie to avoid inconvenience. When Nancy asked her 2 1/2- year-old if he wet his diaper, he responded with an emphatic no when his diaper was soaking wet. He lied because he wanted to keep playing with his trucks and did not feel like being interrupted by a diaper change. According to Dr Reddy’s studies on lying, as toddlers grow older, they continue to lie more often to learn what kinds of lies work in certain situations and what kinds of lies they can get away with. Toddlerhood is also the time children learn the negative consequences of lying. While they often lie to avoid punishment and negative consequences, they soon learn that their lies often result in the same punishment and negative consequences they initially and ironically tried to avoid.

PRESCHOOL LIARS

Ages three to five is a confusing age group in that this is when the child’s fantasy and reality worlds collide. At this stage of development, preschoolers continue to lie to make themselves look good. They also engage in a great deal of wishful thinking, which often results in deceitful behaviour. Children of this age often tell you about imaginary friends and imaginary scenarios.

After four-year-old Bobby told his mom that he had put away all his toys, she found that they were still spread all over the floor of his room. In his developing mind, his fantasy of imagining that he had picked up his toys may have seemed natural to him. While he did not pick up the toys, he may have thought about it before he got sidetracked to going out and playing. Similarly, mom Karen overheard her preschool son Randy talking to her neighbour and their son about how Randy went to a local farm and played with Mickey Mouse, who gave him a birthday present of Legos. First of all, Randy had never been to the farm; second, Mickey Mouse, whom Randy saw last summer in Disneyland, resides in Disneyland, not on the farm; and third, Randy’s birthday was not until three more months. Therefore, he never got Legos because it was not his birthday yet. So Randy told several lies in one.

If we dissect his lies, however, we will see that Randy collapsed his fantasies and wishful thinking into reality to make himself look good in the eyes of his neighbours. Randy saw a local farm television commercial and wanted to go there. He knew that Mickey Mouse lived in some amusement park, so he placed Mickey on the farm in his fantasy. He also knew his birthday was coming up in a few months and wanted Legos, so this final bit of wishful thinking helped create the basis for his lie. Parents must be particularly vigilant about being consistent during this crucial stage of development and help set their preschoolers straight in terms of what is fantasy and reality so that the child learns that lying is not acceptable.

GRADE-SCHOOL LIARS

When a child attends school, teachers and peers usually reinforce the idea that lying is wrong and that one must always tell the truth. Most teachers are on to the “the dog ate my homework” excuse and will not let a child get away with lying. Likewise, if a child’s fellow students know he is exaggerating or lying, they will usually not hesitate to call him. Nevertheless, because school-aged children’s desire to fit in and be socially accepted is so strong, they will often continue to make themselves look good, even if it means lying. For instance, they may often lie about how well they did on a test when they may not have done very well. They will also continue to lie out of convenience. For example, a child may lie that she took a bath and brushed her teeth when she did not because she was too busy playing video games and did not want to be inconvenienced.

The concept of truthfulness can be very confusing to the school-aged child whose parents, teachers, and peers have drummed into him that lying is verboten. Thus, he will often try to tell the truth because he aims to please others. However, in his attempts at being truthful, he may become too truthful and quickly learn that he cannot always tell the truth or he will hurt someone’s feelings. Tommy quickly learned that whenever he lied, it meant that he lost his Internet game privileges. So he made it a point always to try to tell the truth. Nevertheless, his strict adherence to truth-telling was met with confusion at school after he got in trouble for making a female classmate cry by telling her the truth—that he did not want to hold her hand during dance class because he thought she was ugly, smelled terrible, and had sweaty hands.

Tommy’s parents had to explain that “sometimes you have to lie” and not tell the truth not to hurt someone’s feelings. They explained that even though his infant cousin may look like a monkey without a tail (as he once relayed), he must never say that to his aunt or uncle, or their feelings would be hurt. So to add to their confusion, children at this age learn that it is sometimes okay to lie by omission and not always share the truth.

It should also be pointed out that this age of development is crucial for parents to avoid the creation of habitual or pathological liars. Research has shown that children who are severely punished, or given significant punishments for minor infractions, will learn that their fear of punishment outweighs their fear of lying. Therefore, because of the harmful physical and emotional conditioning, such children may protect themselves by continuing to lie to the point where they become habitual or pathological liars.

TEENAGE LIARS

When teenagers lie, it is usually to assert their independence and test boundaries so that they can explore the forbidden, such as sexuality, drinking, smoking, or even taking drugs. Sheila told her mother she was going to Jessica’s house to study. She even called home at dinner time to ask permission to have dinner with Jessica and her family and stay into the evening so they could both study for their exam. Sheila even put Jessica on the phone to reassure her mother that everything was fine with Jessica’s family regarding Sheila coming for dinner. Sheila’s mother was thrilled that her daughter was finally becoming serious about her studies, so she readily agreed to her daughter’s request. Little did she know that Sheila and Jessica were on a double date and that there would be no studying. Sheila’s mother called Jessica’s home around 9 p.m. to ensure everything was fine and to ask when she should pick up her daughter. It was a huge surprise when Jessica’s mother informed her that Sheila had never been there; in fact, she thought Jessica was at Sheila’s house having dinner. Sheila lied because she knew her mother would not agree to her going out on a date during the week, let alone go out with a boy her mother did not know. If teens are caught in a lie, they will often continue to lie to protect themselves or get the demands of their parents, teachers, and even peers off their backs. Even when Joe’s mother had found several joints in his drawer when she was looking for a pen in his room, Joe insisted that the joints were not his and that someone else must have put them there. Even when pressed, he continued to maintain his innocence, insisting to his mother that he never smoked marijuana, even though he got high almost every day.

As you can see from this example, teens will lie to look good in front of others. Joe would never admit that he had ever tried drugs because he would never want his mother to think he was anything but an ideal son. Teens will also lie to look good in front of their peers, as they crave social acceptance and want desperately to fit in. That is why teen boys often lie about their sexual experiences in front of their friends. In contrast, teenage girls will often lie about how popular they are and often exaggerate and over-dramatize experiences and even feign illness to gain sympathy or attention from peers and family members. If a teenager finds that he can repeatedly get away with lies, he may incorporate lying as a way of life. While he may know that what he is doing is wrong, he

I may do it anyway.

Adolescence is the most crucial time in a teen’s life. At this time, they should Be closely monitored by parents and teachers for lying. Authority figures must set boundaries and consequences for lying to make it more difficult for teens to lie. If not, they will be more likely to carry this toxic behaviour into adulthood.

According to the 2001 Indian Census, there were 21.9 million people (2.1 % of the population) living with disability, the majority located in rural areas (75 %) and most unemployed (65.5 %). Understanding the differential employment of persons with disability (PwDs) is especially relevant since the national government has adopted progressive disability law in the last two decades.

Indian disability legislation dates as far back as the 1987 Mental Health Act, followed by the 1992 Rehabilitation Council of India Act, which supported the growth of human resources within the disability rehabilitation sector. India was the first South Asia to sign the Proclamation on the Full Participation and Equality of People with Disabilities in Asia and the Pacific. This resulted in the 1995 Persons with Disabilities (Equal Opportunities, Protection of Rights and Full Participation) Act. The Act was known to be one of the most comprehensive pieces of legislation pertaining to persons with disabilities in the region. Specific to employment, it had provisions on non-discrimination in the built environment and in government employment. It gave statutory recognition to an employment reservation policy of 3 % in government and public education institutions. Specifically, a 1 % reservation is required for three disability categories combined: hearing, vision and locomotor. Further, an unemployment allowance exists for those registered with the Special Employment Exchange program (a national employment service) for more than two years without securing employment.

In the past three decades, the concept of disability has shifted from individual impairment to a more social phenomenon. Thus, disability is a complex phenomenon, reflecting an interaction between features of a person’s body and features of the society in which he or she lives. In this view, persons with disabilities are seen as restricted in performing daily activities because of a complex set of interrelating factors, some about the person and some about the person’s environment and social/political arrangements. The social concept of disability introduces the notion that society has erected physical or attitudinal barriers that affect a person with disabilities. Consequently, government programs and policies have evolved to include fixing the environment (e.g., making buildings barrier-free) and providing income assistance or work-related support to help persons with disabilities participate more fully in the community and the workplace. Even the World Health Organization (WHO) goes beyond a medical approach to a broader view of disability. It also recognizes the role environment plays in either facilitating functioning or raising barriers.

It is a well-accepted fact that mental illnesses are also associated with a significant disability. Mental disorders account for nearly 31% of the world’s disabilities. It was found that five of the ten leading causes of disability worldwide are in the category of mental illnesses: major depression, alcohol dependence, schizophrenia, bipolar affective disorder and obsessive-compulsive disorder. World health report 2001 by the WHO assessed the leading causes of disability using disability-adjusted life years (DALY). Mental illnesses accounted for 25% of total disability and 16 per cent of the total burden.

In their very nature, psychiatric disorders display a different pattern of disabilities than physical ailments. It is important to note that social and work-related functioning is more important in those with mental illnesses. We also need to remember that mental disability in the form of apathy, motivation, poor self-care communication difficulties and poor interpersonal skills are not visible, unlike other disabilities, viz. blindness or locomotor disability. There were instances when disability benefits like bus passes were denied because they looked physically strong. Stigma and discrimination compound it. It is in this context that measures of psychiatric disability have been designed.

Research initiatives in the area of psychiatric disability in India have focused more on schizophrenia. Attention has been given to two critical issues: The development or modification of scales for assessments and disability evaluation in persons with chronic psychiatric illnesses. Disability has been assessed in psychiatric patients in different settings such as hospitals, communities and follow-up studies. As early as 1979, Wig et al. constructed a scale to measure the disability of Indian psychiatric patients. They found that psychotics (ICD-8) obtained significantly higher scores than neurotics, and persons with more significant personal disability accepted treatment more often than those with less personal disability scores.

A decade later, Thara et al. modified the Disability Assessment Schedule (WHO DAS-II) by deleting certain items and regrouping the rest into four primary areas of personal, social, occupational and global disability because the DAS II was not entirely culture-free. This modified instrument was developed, validated and called the Schedule for Assessment of Psychiatric Disability (SAPD). They also administered this to 30 patients in the three psychoses, neurotics and diabetics groups. It was found that the SAPD effectively discriminated against the psychotic group from the other two groups. Therefore, the authors recommended this instrument for measuring disability in outpatient psychiatric populations.

Further, Thara and Rajkumar followed up 68 schizophrenia patients prospectively for six years using standardized instruments. Disability was assessed using the SAPD at the end of four, five and six years of follow-up. They found that the three-year course of disability tended to be stable without any fluctuations and that the highest disability was in occupational functioning. Moreover, the disability was not related to the number of relapses. The authors noted that this could be due to the following factors: The cohort was closely followed up and well treated; all patients started treatment early in the course of their illness.

Mohan et al. undertook a tertiary hospital-based study to assess and compare disability using the IDEAS in patients with schizophrenia and obsessive-compulsive disorder. They included patients with only mild severity illness. The majority of the schizophrenia patients were from rural areas, whereas most of the OCD patients were from urban backgrounds. Patients in both groups had a considerable global disability. Understandably, schizophrenia patients had significantly greater disabilities across all domains of IDEAS. Duration of illness did not affect disability scores in schizophrenia patients, but it harmed OCD.

Srinivasa Murthy et al. assessed the costs and effects of a community outreach program for untreated schizophrenia patients in a rural community. A hundred cases were recruited and provided appropriate psychotropic medication and psychosocial support. They also assessed every three months over one and a half years on symptomatology, disability, family burden, resource use and costs. Results showed that summary scores of disabilities along with psychotic symptoms and family burden were reduced over the follow-up period. These were also accompanied by reductions in the costs of informal-care sector visits and family caregiving time.

Choudhry et al. assessed some aspects of disability associated with seven psychiatric disorders: Schizophrenia, bipolar affective disorder, anxiety disorder, depression, obsessive-compulsive disorder, dementia and mental and behavioural disorders due to the use of alcohol. They aimed to: Evaluate the nature and quantity of disabilities in the study groups, compare the degree of disability with the severity of the disorder, compare disability among various disorders and study the longitudinal stability of disability in the disorder groups. They assessed 228 patients attending the outpatient department of Assam Medical College, Dibrugarh, India, between July 2003 and June 2004. Patients were initially diagnosed using the ICD-10 criteria.

Further, interviewers administered a schedule for a clinical assessment for neuropsychiatric (SCAN) for those who consented to participate in the study. The severity of the disorders was assessed by applying commonly used rating scales for each specific disorder. Disability was assessed using the Indian Disability Evaluation and Assessment Scale (IDEAS). Patients were followed up at six and 12 months. Results showed that all seven disorders studied were associated with significant disability, schizophrenia being maximally disabling. The domains of disability varied across the various disorders studied. The disability tended to correlate with the severity of the disorders. Disability associated with alcohol use disorder and anxiety was comparable to disability due to obsessive-compulsive disorder. Though the follow-up rates were low, analysis of the available data showed that the disability across most disorders reduced at the end of the six-month follow-up and tended to even out after that period.

Shankar et al. reported the gender differences in disability among married patients with schizophrenia. The study sample included 30 married patients of both sexes. Disability was evaluated using the modified version of the Disability assessment schedule. Results indicated that women were more disabled than men, in contrast to the findings from literature elsewhere. In addition, negative symptoms predominated among the factors associated with global disability in both sexes.

Tharoor et al. cross-sectionally compared the inter-episode quality of life (QOL) and disability of patients with the remitted bipolar affective disorder (BAD) or recurrent depressive disorder (RDD) with and without comorbid chronic medical illness. Assessments were carried out on the four subgroups (20 patients each). QOL assessment was carried out using the World Health Organization (WHO)-QOL-Brief Kannada version, and disability was assessed using the schedule for assessment of psychiatric disability (SAPD), which is the Indian modification of the WHO disability assessment schedule-II. In patients with medical comorbidity, BAD patients were significantly more disabled in the ‘social role’ domain when compared with RDD patients (P 5 0.04), while RDD patients were significantly more disabled in the ‘home atmosphere’ domain (P 5 0.001). In patients who did not have medical comorbidity, BAD patients were significantly more disabled in the overall behaviour domain when compared to RDD patients (P 50.002);

In contrast, RDD patients were significantly more disabled in ‘the assets and liabilities (P5 0.004) and home atmosphere (P 5 0.001) domains. The QOL measures did not differ significantly between the two disorders. The authors concluded that medical illnesses might have a role in increasing disability but are less likely to impact QOL in mood disorders when patients are significantly euthymic.

Kumar et al. assessed the prevalence and pattern of mental disability in a rural taluk of the Karnataka district. This was a community-based cross-sectional study. One thousand subjects were randomly selected from four villages, and IDEAS was administered. The overall prevalence of mental disability was 2.3%. Among the disabled, most had mild disability, followed by severe, moderate and profound severity. All disabled subjects were previously diagnosed with one mental disorder such as Affective disorders, mental retardation, epilepsy, neurosis, schizophrenia, and alcohol addiction.

Krishnadas et al. measured cognitive dysfunction in 25 remitted schizophrenia patients attending a general hospital psychiatry unit. Remission was confirmed using the brief psychiatric rating scale (BPRS) and the scale for assessing negative symptoms (SANS). The following neurocognitive measures were used: PGI memory scale, Trail making tests A and B, Rey-Osterrieth complex figure test and frontal assessment battery. Disability was assessed using the IDEAS. Results showed that patients had considerable cognitive dysfunction across all measures. Moreover, the authors did not find a statistically significant relationship between cognitive dysfunction and disability scores.

Gururaj et al. assessed the disability, family burden, and quality of life of moderately ill obsessive-compulsive disorder (OCD) and compared those with schizophrenia patients of comparable severity. Disability was assessed using the WHO-DAS. Results showed that both groups were similar across most domains of disability. The authors concluded that OCD is associated with significant disability often comparable to schizophrenia.

Thirthalli etal. assessed disability in 182 community-dwelling schizophrenia patients in Thirthalli taluk of Shimoga district of Karnataka using the Indian Disability Evaluation and Assessment Scale (IDEAS). They aimed to compare the disability of schizophrenia patients receiving continuous antipsychotic treatment with those not taking antipsychotics or taking irregular treatment. Results showed that patients on antipsychotics had significantly less disability across all domains and in total IDEAS scores. Treatment status predicted disability scores even after controlling for the effects of controlling factors like age, sex, education, socioeconomic status, duration of illness and alcohol dependence/ harmful use. Different levels of exposure to antipsychotics were associated with different levels of disability. Though there was no randomization, this study was conducted with a naturalistic design. The two groups did not differ in clinical or socio-demographic variables. The authors concluded that treatment with antipsychotics is associated with significantly less disability.

Thirthalli et al. compared the course of disability in schizophrenia patients receiving antipsychotics and those remaining untreated in a rural community. Of the 215 patients identified, 58% were not receiving antipsychotics. Trained raters assessed the disability (IDEAS) in 190 of these at baseline and after one year. The course of disability in those who remained untreated was compared with that in those who received antipsychotics. Results showed that in patients who remained untreated, the mean disability scores remained unchanged, but in those who continued receiving treatment and in those antipsychotics were initiated, the scores showed a significant decline (indicating decrement in disability). Furthermore, the proportion of patients classified as ‘disabled’ declined significantly in the treated group but remained the same in the untreated group. The authors concluded that treatment with antipsychotics in the community results in a considerable reduction in disability.

LEGISLATION FOR THE BENEFIT OF DISABLED PERSONS

As a signatory to the proclamation adopted in the meeting to launch the Asian and Pacific decade of disabled persons 1993-2002 at Beijing from 1st to 5th December 1992, India had to enact a law to benefit the disabled. Hence the persons with disabilities (Equal opportunities, Protection of rights and Full Participation) Act 1995 was passed in the parliament. Mental illness was included as one of the disabilities. Two important gazette notifications in this regard are:

1. Ministry of Social Justice and Empowerment Notification [Gazette no 49 dated18th Feb 2002], which states that

• Mental illness has been recognized as one of the disabilities
• Defined as any mental disorder other than mental retardation
• A committee was constituted to prescribe guidelines for evaluating and assessing mental illness (Aug 6 2001).

2. Ministry of Social Justice and Empowerment Notification [Gazette No. 49 dated Feb 27 2002]

• Authorities to give certificate will be the medical board constituted by Govt [section (1) and (2) of section 73 of Person with Disability act 1995]
• Certificate valid for five years or permanent
• The Director General of Health Services (DGHS) will be the final authority.

Although PDA 1995 defines mental illness as any mental disorder other than mental retardation and includes only persons suffering from more than 40% disability, not all mentally ill are disabled; hence, the definition has to be changed. One proposed definition in this regard (amendments proposed to the PDA, 1995) is a disorder of the mind that results in partial or complete disturbance in the person’s thinking, feeling and behaviour, which may also result in recurrent or persistent inability or reduced ability to carry out activities of daily living, self-care, education, employment and participation in social life. It is noteworthy in this context that the notification does not require any psychiatric diagnosis for disability. Although several tools that measure psychiatric disability existed, there was a need to develop a simple instrument that led to scores and percentages. Consequently, the Rehabilitation Committee of the Indian Psychiatric Society (IPS) developed the Indian disability evaluation and assessment scale (IDEAS) in 2002.

IDEAS was field tested in nine centres all over India and has now been gazetted by the Ministry of Social Justice and Empowerment, Government of India, as the recommended instrument to measure psychiatric disability (Thara 2005). According to the IPS, only patients with the following diagnoses per ICD-10 or DSM criteria are eligible for disability benefits: Schizophrenia, OCD, bipolar disorder and dementia.

Government benefits for the disabled include

• Travel concession in Railways: 75% concession to the disabled and an accompanying person
• Annual passes at concessional rates by the State Road Transport Corporations
• Monthly maintenance allowance: Rs 400/- (for persons with disability between 40 and 70%)and Rs 1000/- for those whose disability exceeds 70%
• Benefits under various welfare programs like the Rojgar yojanas
• Income tax benefits
• Family pension: This will be given to the disabled after the death of parents
• Employment reservation: Three to five per cent of jobs in the Government are reserved for the disabled; the Government has also identified jobs for the mentally ill in this sector. In this context, it may be noted that the education department in a particular state government had reserved five per cent of its posts for the disabled; of this, one per cent is exclusively reserved for people with mental illness and 1% (only group-D posts) is exclusively for persons with mild levels of mental retardation
• Encouragement of students/self-employment.

However, the number of patients getting benefits under the disability act is deficient because of many barriers, as listed below.

CHALLENGES AND BARRIERS OF DISABILITY IN MENTAL ILLNESS

Attempts to improve the fate of the mentally disabled, especially in developing countries like India, face many obstacles. Stigmatization and discrimination come in the way of the mentally ill receiving total disability benefits. People may have preconceived notions about the mentally ill - that these people are lazy or dangerous. These will significantly affect how individuals come to see themselves and lower their self-esteem (Self-stigmatization), which may worsen their disability. The levels of knowledge of mental illness do not correlate with discriminatory attitudes. Even a proportion of medical personnel who are well informed is not tolerant towards the mentally ill. Consequences of discrimination include increased vulnerability to a disability, magnifying the impact of illness, and depriving care and treatment. There also exist many barriers for the disabled to access due benefits. These include Stigma, poor knowledge about the IDEAS, fear of Misuse of Certificates, discomfort in approaching government hospitals, time constraints, rigid negative thinking about legal issues, denial of disability, and ‘outside’ pressure to issue disability certificates.

FUTURE DIRECTIONS AND CONCLUSIONS

The following are a few suggestions:

• The disabled should demand benefits; we should remember that the family has the prime responsibility to look after the disabled and get the benefits due to them
• The voice of the disabled needs to be recognized by the Government
• Strong encouragement and assistance need to be given to people with mental disability and their representatives to form organizations
• Information regarding disability needs to bed is seminated far and wide across the country
• The attitude of a professional needs to change
• organized monitoring of disability services and benefits disbursed is needed

• Lacunaein mental health law includes the need to periodically review existing legislation and plan amendments or bring in new legislation from time to time • There needs to be more research on factors associated with disability and psychiatric disorders

Assessment of Personality

1.      Interview

2.      Observation and behavioural assessment

3.      Psychological tests

4.      Self-report measures

5.      Projective tests

Interview

·       Interview refers to direct face-to-face encounters and interactions.

·        Verbal, as well as non-verbal information, is available to the psychologist.

·        Interviews are usually used to supplement information gathered through other sources.

·     Skill of the interviewer is very important since the worth and utility of the interview depends on how well he can draw relevant information from the interviewee.

Behavioural Assessment

Direct observation measures for studying and describing personality characteristics.

Psychological Tests

In order to objectively assess personality and behaviour standard measures are devised. These measures are called psychological tests. Psychological tests have to be valid and reliable. Besides, they need to be based on norms.

Self-Report Measures

Measures wherein the subjects are asked questions about a sample of their behaviour. These are paper and pencil tools or tests.

MMPI (Minnesota Multiphase Personality Inventory)

• ·   The most frequently used personality test. It was initially developed to identify people having specific sorts of psychological difficulties. But it can predict a variety of other behaviours too.
• ·   It can identify problems and tendencies like Depression, Hysteria, Paranoia, and Schizophrenia for example.
• ·      At the same time, it has been used to predict if college students will marry within 10 years and whether they will get an advanced degree

Projective Tests/Techniques

Tests in which the subject is first shown an ambiguous stimulus and then has to describe it or tell a story about it

The most famous and frequently used projective tests are:

1. ·         Rorschach test, and
2. ·         TAT or
3. ·         Thematic Apperception Test

Rorschach Test

The test consists of Inkblot presses. These have no definite shape. The shapes are symmetrical and are presented to the subject on separate cards. Some cards are black and white and some are coloured.

The procedure of Rorschach administration

·         The subject is shown the stimulus card and then asked what the figures represent to them?

·         The responses are recorded.

·         Using a complex set of clinical judgments, the subjects are classified into different personality types.

·         The skill and the clinical judgment of the psychologist or the examiner are very important.

Thematic Apperception Test/TAT

A series of ambiguous pictures are shown to the subject, who has to write a story. This story is considered a reflection of the subject's personality.

·         The subject is asked to describe whatever is happening in it just like forming a story.

·      The subject has to tell what is happening in the scene, what the antecedent conditions were, who the characters are, what are their thoughts and wishes, and what is going to happen next.

·         In short, the subject describes the past, present and future along with the description of characters and their thinking and motivation.

Psychopathology

•    Psychological illness, psychological disorders, or mental illness are referred to as psychopathology.
• The term is used to describe abnormal behaviour.
• Psychopathology is the area of study in psychology that primarily focuses on the origin, development and manifestation of behavioural and mental disorders.
• Abnormal psychology is a branch of psychology that studies, describes, explains, and identifies abnormal behaviour.
• The observable behaviour and mental experiences of an individual may be indicative of a mental or psychological disorder. The overt behaviour and other experiences provide cues to the development of mental or psychological disorders.
• Psychiatrists and clinical psychologists treat mental disorders.
• Besides, they are also interested in studying and conducting research on the nature and role of the events that cause these disorders e. g. past history of a person and other variables that contribute to mental illness.

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Here are some signs that you suffer from toxic productivity. 

To overcome toxic productivity, first, monitor your work hours to see how long you can work before you feel exhausted.

Next, delineate a clear boundary between work and rest once you hit those hours, even if you work at home. Firstly, in space, which means moving to a different room to rest.

And, in time, stop yourself from working at that time. This forces you to only work on what's important every day.