In the past decade, India has seen a rise discussion on mental health issues. The importance is understandable once we look at the recent ranking of India by WHO, as the most depressed country followed by China and USA. A WHO report says that in India an estimated 57 million people are affected by depression. This is 18% of the global estimate, while according to India Today, “the average suicide rate in India is 10.9 for every lakh people and the majority of people who commit suicide are below 44 years of age.”
To get an insight into the ground-reality of mental health in India, we spoke with Sadaf Vidha, a 26 year old psychologist and therapist who is currently working with project Sukoon, while also engaging in online treatment and therapy.
What do you think of the current state of mental health discussions in India?
While awareness is definitely better today than say a decade ago, we still follow a medical model of mental illness where we locate the problem inside the person, not giving enough weightage to issues of class, caste, gender, sexuality, upbringing, abuse, trauma etc. This is disempowering and at some levels, also very limiting, because if you do not cover all the factors, you cannot provide adequate solutions. Lack of certainty like job loss, poverty, etc do make us anxious because they’re supposed to, our mind is supposed to alert us to these situations so that we can change them. Thus, we can’t fault people for structural problems or the things that government should be doing to provide basic safety and certainty. So I feel the conversation now needs to be nuanced to factor all this in.
What according to you is the perception about mental health among youth today, given it’s a topic now heavily discussed?
A lot of my clients are young so I definitely think that they take it seriously. It helps that celebrities are normalizing it. What they struggle with is to convince their parents of this being an actual thing to work on and secondly, when they know their distress was caused by dysfunctional parenting and family patterns, they are met with huge resistance and thus they struggle with that. However the popular discourse is still a very internalizing one, it doesn’t talk enough about external causes and so young people do tend to feel they’re the weak or faulty ones to have a mental health issue.
Lack of certainty like job loss, poverty, etc do make us anxious because they’re supposed to, our mind is supposed to alert us to these situations so that we can change them.
Do you think the discussions on mental health are inclusive enough? What can be done to make them so?
I think they’re still privileged discussions. Since I also work in some non-private setups, I know how different that world is and how little the awareness. Often the resources are catered only to the well informed and articulate. We need more discussions involving Dalits, Muslims, women, queer people, young children, and older people. A lot of these groups feel disenfranchised in the current political climate and this also adds to the distress.
What do you think of the misinformation people have regarding mental illnesses courtesy movies and unverified surface level information in this age of digital media?
The biggest issue with how mental health is portrayed is about how therapy or treatment takes place and what recovery looks like. Therapy is hardly how it’s shown in Dear Zindagi. Therapy is a process where the client is an active part, there is a lot of back and forth, discovering patterns and coping and it’s not a linear journey. Secondly, recovery is shown as a ‘fully functional’ state which we are moving towards but for a lot of people, that’s not possible. You can’t just get over childhood trauma, sure you learn and heal and adapt but this idea of recovery which doesn’t allow any variations is very unhelpful.
Eating disorders are not talked about enough in this discourse when almost every woman struggles with body image and the conventional standards of beauty. What according to you cause them and what are the deeper socio-psychological trends leading to body image issues?
Culture does play a big role. Women’s worth is attributed to their bodies and controlling their eating habits is a way in which women feel they can manage how they look and thus feel worthy. PM Modi said when asked about malnutrition that it was because girls are dieting, and it became a laughing matter. So both malnutrition and eating disorders are not given their seriousness thanks to these perceptions.
Eating is also something most of us find pleasurable and so, when we restrict eating, the base could be to stop ourselves from doing something that feels good and punish ourselves, which has roots in self esteem issues.
Lastly, food is the only thing women can control when their families decide their clothes, their schools, their careers and their husbands. So they control the one thing they can. Having worked in a school I know the torture that girls who won’t fit a certain mold of looks go through, their own parents call them names. We don’t have a healthy culture at all. Another problem is this is said in the guise of fitness and health, but it’s very clearly fat shaming.
How much and how differently do you think women experience mental health issues and what are the reasons?
Women seek more help and form a larger part of the patient/client base, for two reasons. One, women internalize their problems (part of depression etc is internalization) and two, due to their social nature, women can seek help, and emotional expression comes naturally to them. However, women are also more likely to be misdiagnosed with mood disorders, because the male body is considered typical in medicine, and so is male behaviour, and so women’s natural mood cycles or behaviours are pathologised, as seen by diagnoses like pre-menstrual mood disorder. The psychiatry field also does a disservice to women when it comes to sexual disorders because there too, the male pleasure cycle is considered normal and the pain experienced by women during sex is pathologised. Also, sexual abuse or trauma is not even asked about. And of course, psychiatry has no place for queer and trans women.
Speaking of gender-based realities, women have multiple layers of demands and oppression. They have to walk a tighter rope to be worthy and they do way more unpaid work and put in a lot of emotional labour. They are often discouraged from having an identity outside of relationships, which makes them dependent on people around them, thereby making them more vulnerable to abuse and also, for feeling stuck in life once they are no longer required to do caregiving roles.
There is still a lot of stigma around seeing a therapist and also the problem of therapy being expensive. What do you think can be ways to help those suffering from psychological disorders who cannot afford the traditional mode of treatment?
The issue here is multiple-faceted. the first thing required is to increase the mental health budget of the country, which is at 0.06% right now. This will ensure a whole lot more government mental health facilities- which could include helplines, shelters, crises centers. Secondly, insurance in India largely does not cover mental health, though they’re supposed to by law. this would help a lot of people. Thirdly, there could be public-private partnerships where therapists could be encouraged to taking a few clients on pro bono basis in return for some benefits by the government.
Speaking of gender-based realities, women have multiple layers of demands and oppression. They have to walk a tighter rope to be worthy and they do way more unpaid work and put in a lot of emotional labour.
Another idea is a therapy allowance which is made mandatory for all employees of big companies, they spend a lot on wellness, so this would not be new. Lastly, task shifting and group work is important. Task shifting is a concept that believes that everyone does not require specialist care, so we could have barefoot counselors, nurses etc to train in basic mental health first aid, and they could ensure that basic care is provided and then only those who need more care see a specialist. Secondly, support groups, group therapy etc are very empowering and cheaper and can be used to cut costs.
Lastly, the best way to help people in this area is prevention, being more proactive about emotional health in schools and colleges, ensuring safety of children and women from violence and trauma, and ensuring plans that build resilience, will go a long way not only in cutting costs but will finally also relieve the burdens from those who anyway have structural oppression happening against them.
Finally, what is your advice to young students to remain mentally healthy when there’s so much pressure in them?
Firstly, realizing that the strict paths that have been carved out for them are not necessarily the key to happiness. Students put up with this thinking that being okay with the rat race and exhausting yourself is the only way to have a good, happy life but it’s just not true. Unemployment affects even the most hard-working of people. So question all these concepts that have been taught to you, seek out alternate evidence and literature. Have your own values of what makes life meaningful for you and pursue that. Get help from community, friends and professionals if certain ways of thinking and feeling, or events of your past are making you feel stuck or stagnated.
Picture Credits: NewLoveTimes
Snigdha Gupta is an intern with SheThePeople.Tv