LEPROSY: A BODY, BRAIN, MIND & LIFE DISEASE
Leprosy generates a number of psychological and psychiatric problems related to trauma-spectrum disorders, including anxiety, depression, dissociative disorders, adjustment disorder, borderline personality disorder and PTSD. These psychiatric disorders share in common a basis in brain abnormalities that are caused by stress. Unfortunately, most psychiatrists still ignore the problem and, as a result, there is a lack of research programs aimed to a better comprehension and therapy of anxiety-related disorders in leprosy patients.
Two years ago Senturk and Sagduyu reported: “The prevalence of mental disorders among leprosy patients is higher than that among general population. Depression is the most common psychiatric disorder among leprosy patients. Another important finding is that the long duration of the illness and physical handicaps raise the risk of psychiatric disorders […]. A review of the literature revealed several papers on the psychosocial aspects of illness but few references to the degree or pattern of psychiatric disorders among leprosy patients”(Senturk V. & Sagduyu A., Psychiatric disorders and disability among leprosy patients; a review. Turk Psikiyatri Derg. 15, 236-243, 2004).
In the same period Leekassa and colleagues studied prevalence of mental distress among outpatients of a specialized leprosy hospital in Addis Ababa. They found that physical disabilities were strongly associated with mental distress and observed: “Future work should be directed at further characterizing the nature and severity of mental disorder in this group”(Leekassa R., Bizuneh E., Alem A., Prevalence of mental distress in the outpatient clinic of a specialized leprosy hospital. Lepr Rev. 75, 367-375, 2004, See also comment in: Lepr Rev. 76, 263-264, 2005).
Japanise researchers studied association of depressive status in leprosy patients with self-percetion of stigma (Tsutsumi A. et al. Depressive status of leprosy patients in Bangladesh: association with perception of stigma. Lepr Rev. 75, 57-66, 2004).
In recent years perception of stress-related disorders caused by physical diseases has greatly changed, mainly thanks to the work of psychiatrists like Douglas Bremner (J. Douglas Bremner, Does Stress Damage The Brain? Understanding Trauma-Related Disorders from a Mind-Body Perspective. Norton, New York 2002), and now many researches have revealed PTSD-like syndromes almost in all medical fields; nevertheless there are a number of problems to diagnose such disorders in leprosy patients. First of all, we think, to improve diagnostic efficacy it is required a closer relationship between psychiatrist and patient, and a psychotherapy-like setting. We think that the distance generated by the employ of formal testing and other epidemiological tools, can interfere with the building of empathetic relationships. A “wholistic medicine” –as termed by Linda Faye Lehman- could be the best approach both for diagnosis and therapy.
As Richard Mollica observed about diagnosis of PTSD in Third World Countries, there are cultural problems related to the representation of illnesses and diseases: psychological disorders are often regarded by people as a spiritual rather than medical matter. A unified mind-body approach to leprosy also needs to take into account the spiritual beliefs and cultural contexts of the individual that may have the potential to promote or obstruct the path to recovery.