If you have Psychosis/ Neurosis/ Mental Retardation you cannot join Medical Post graduation courses:  Medical Council of India 2018

Dr Harish Shetty

[Letter to the Health Minister ; Govt of India]

This is a shocker! As the admissions for Post graduation Medical Courses 2018 are on after the P.G NEET results the Certificate of Medical Fitness Annexure “N” has six exclusion criteria of which number [4] states that the candidate should have absence of Psychosis/ Neurosis / Mental Retardation.

It is a shocker because firstly the terms Psychosis & Neurosis are archaic. Neurosis is defined as , ‘A relatively mild mental illness that is not caused by organic disease, involving symptoms of stress (depression, anxiety, obsessive behavior, hypochondria) but not a radical loss of touch with reality. This is a rough definition though the clear cut division of Psychosis and Neurosis is not acceptable today as there may be overlaps.

Let us look at a scenario of an M.B.B.S student who has had an episode of ‘Depression’ in the first MBBS. He is treated and recovers to finish his MBBS but is on medications for maintenance of his improvement just like those suffering from diabetes, hypertension e.t.c. Is he not eligible because technically he is a patient suffering from Depression? If a young medico suddenly has an episode of excessive hand washing and recurrent irrational thoughts she is said to be suffering from Obsessive Compulsive disorder. She is being treated with medications and Cognitive Behavior therapy. She recovers partially and finishes her MBBS course. She is effectively working as an Intern and so does she fail the criteria for P.G admissions.

Scores of students have ‘panic disorder’ and may be on some treatment. I have treated so many across two and half decades. Many are outstanding professionals even today but are on continuous treatment. Many students may have multiple episodes and may have recovered with treatment for mental illness and are desirous of doing their Post graduation.

The Disability Act 2017 is An Act to give effect to the United Nations Convention on the Rights of Persons with Disabilities and for matters connected therewith or incidental thereto. WHEREAS the United Nations General Assembly adopted its Convention on the Rights of Persons with Disabilities on the 13th day of December, 2006; AND WHEREAS the aforesaid Convention lays down the following principles for empowerment of persons with disabilities,— (a) respect for inherent dignity, individual autonomy including the freedom to make one’s own choices, and independence of persons; (b) non-discrimination; (c) full and effective participation and inclusion in society; (d) respect for difference and acceptance of persons with disabilities as part of human diversity and humanity; (e) equality of opportunity; (f) accessibility; (g) equality between men and women; (h) respect for the evolving capacities of children with disabilities and respect for the right of children with disabilities to preserve their identities;

The certificate of medical fitness violates the above tenets of the Disability act where Mental illness is one of the 21 disabilities mentioned. The medical certificate is a little wiser when it talks about physical illness. Clause [1] says “Absence of any incapacitating and/or progressive systematic disease/disorder/condition”. Here the intensity of the illness is attempted to be described though it remains as confusing with the terms mentioned.

There are many students who are well maintained with ‘Anti psychotic drugs’ and have a diagnosis of Bipolar Disorder or even well maintained students with ‘Schizophrenia’. Would those students who have attempted suicide in their M.B.B.S be excluded for Post graduation because they be interpreted as probably ‘Neurotic’.

This certificate is supposed to be signed by a Registered Medical Practitioner. Is an R.M.P with an M.B.B.S equipped and qualified to say that the candidate has absence of Psychosis/Neurosis/ Mental Retardation.

Will a candidate who has been ill ever declare and say the truth about mental illness with a certificate that is vague and discriminatory. S/he will hide it for sure. This certificate increases the ‘stigma’ towards the mentally ill. I agree that Mental Retardation gets automatically excluded as those with this disability will not reach M.B.B.S.

N.I.M.H.A.N.S recently in their study found 14.3 % of Indians to be mentally ill. With better treatment many of the illnesses can be easily treated.

The blanket statement; “Absence of Psychosis/ Neurosis / Mental Retardation” has caused a lot of confusion of what the sentence actually means. This confusion needs to be cleared.

The Medical Council of India needs to urgently look at the certificate and clear the air of confusion it has caused.

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