Wellness & Fitness

Is mumbling to oneself a sign of mental illness?

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Pin-pointing mental illness is not a black and white matter as different people demonstrate diverse signs. There is need to look at various symptoms before making a conclusive diagnosis on an individual. FILE PHOTO | NMG

Qn.“I have lately noticed a trend where many people are mumbling to themselves in public. Is this a sign of growing mental illness?

Your question is not entirely clear and so I will assume you are asking two questions. The first is whether mumbling to oneself is a sign of mental illness, and the second whether there is evidence that mental illnesses are generally on the increase.

With regard to the first question, the answer is that some people with mental illness mumble to themselves, but also that some people without mental illness also do the same.

We must make a point we have made repeatedly in the past, which is that mental illness is said to exist in a person, when a constellation of signs and symptoms are confirmed to be present. One sign or symptom is not enough.

We know for example that some people with malaria complain of headache.

We also know that some people without malaria also complain of headache. One sparrow, as the old saying goes, does not make a summer! One needs more symptoms to make the diagnosis.

Some years ago, we saw a 60-year-old man who was lying in an orthopedic bed in hospital. His surgeon had called us to see “the old man” because as far as he was concerned, the operation to repair the broken hip had gone well, and the man should be up and about doing physiotherapy and preparing to go home. The referral note stated the following:

“Please find out why this man has refused to go home”. The surgeon was frustrated that his otherwise good work did not seem to have a happy ending. The man remained in hospital for a further two weeks.

During his hospital stay, a number of facts became known and both the surgeon and the family were surprised that this information had been kept away from them.

The first was about the duration of time that the man had been unwell before the fall. For several months, the man had been feeling tired and sad all the time. When he was unable to sleep at night he was given some sleeping pills by a friend who had a similar problem (insomnia). So, like the two people with headache, these two people had different medical conditions. Our patient was diagnosed to have a Major Depressive Disorder, while his friend who was taking the sleeping pills was found to have an overactive thyroid gland. Like murmuring to themselves, two people with insomnia ended up with different diagnosis and, therefore, treatment.

Two women presented to us a few months ago and both had the same presenting symptom; gradual loss of libido. Both stated categorically that they loved their husbands but for several months, they had developed strategies of making sure that sex did not take place. Both were afraid that their husbands would stray and possibly break up their marriages.

In the case of the younger woman, the doctor was able to diagnose and treat postnatal depression. This is a condition that afflicts at least 15 per cent of women following childbirth.

In the case of the older woman, the loss of libido followed a robbery at home in which she and her husband felt so afraid that they thought they would be killed. They were both beaten up by the intruders but the wife later stated that her husband did not “behave like a man”. He shook and trembled and failed to show courage or leadership in front of danger.

She did not feel the protection she felt she deserved from her husband. Both she and her husband were later diagnosed with Post Traumatic Stress Disorder (PTSD) and after several months of treatment, her libido was restored and he no longer abused alcohol (as a symptom of PTSD).

The same symptom (loss of libido) with completely different causes.

With regard to your second question, the answer is yes. It seems that there is a steady increase in the number of people suffering from what the World Health Organisation (WHO) classifies as mental and neurological disorders.

So it is possible that some of the people you have seen in the streets do indeed suffer from mental illness.