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Mental health awareness in India

How stigma remains a hindrance to help

Shabana Rehman 14 Sep 2020

Image Courtesy:dailynurse.com

India, one of the fastest developing countries of today, is still stuck in a time-wrap, when it comes to social advancements and mental health. Social stigma still remains an obstacle to help Indians cope with mental illness. The attitude toward mental health in India is very different from the one in the West. It’s ‘something is wrong with you and it’s your fault,’ instead of ‘this is a medical problem and can be treated’. There's little awareness that it's a real illness. There's still a very deep stigma.

With a population of 1.3 billion people, India (in 2014) had 4,500 psychiatrists, compared to 50,000 in the U.S., about 4,500 in California alone. In India, about 100 million people were believed to suffer common mental disorders and millions more have more severe illnesses at that time. Ironically it is only in urban areas where medication and psychiatrists are available, but in rural areas medication is not available nor are psychiatrists. 1 

Most general physicians fail to diagnose psychiatric illness. A mentally ill patient displays symptoms, which superstitious people believe are paranormal. With the medical system in a mess and awareness about mental disorders lacking, faith healers and quacks are making hay. In rural areas of India, many villagers still believe that evil spirits cause mental illness. So-called therapy, conducted by witch doctors or family members, can include chaining up the mentally ill, chanting spells, poking them with pins, or beating them "to force the spirits out."

According to WHO countries like India devote less than 1% of their health budget to mental health compared to 10%, 12%, and 18% in other countries. But in recent years, the Indian government has increased budgets for psychiatric education and mental health awareness, seeking to curb a sharply rising suicide rate.2  Suicide is now the second-highest cause of death in India among those between the ages of 15 and 29, according to a recent study in the medical journal Lancet. The national suicide rate was about 16 per 100,000 people in 2010, compared to 12.4 per 100,000 in the United States, according to the national Centers for Disease Control and Prevention.3   

When it comes to matters of mental health, culture counts! Cultural perceptions about mental illness and treatment can vary. Some people in India perceive mental illness to be a curse caused by the evil eye or demonic spirits, others believe it is a sign of weakness, and yet others believe they are neuro-biological disorders. In America, most people believe that mental illnesses are neuro-biological disorders, while some believe it’s a sign of weakness. However, it is important to remember that America is a melting pot of immigrants whose perceptions about mental illness are shaped by their cultural legacies, while some cultures have their misperceptions of mental illness which can deter people from seeking lifesaving treatment and support.

"There's a big myth that everything psychiatrists do is so sophisticated and complicated. It scares a lot of people off. Demystifying mental health is important for the social acceptance of this medical help,” said K. Srinath Reddy, president of the Public Health Foundation of India, an organisation working to improve education, research, training and policy in public health. Unfortunately, society still stigmatizes those who suffer from routine psychiatric problems, so their treatment is either delayed or denied by their families or by themselves.  

In America, it is common for ads to be placed on a school notice board about free therapy or some brief psychotherapy research program or help groups saying “Are you Feeling Overwhelmed? “ or “vent with us, come in and talk to us about your experience”. These things make it so easy, so normal, for a student or an adolescent to deal with their ongoing stress or at the least relate to it. People’s minds are trained to seek help, and are taught to believe that it’s a problem and they can get help. Whereas in India there's a gradual increase in awareness that mental illness is a health problem, not a social or personal problem, but it's very gradual.

My reason for this quest, for wanting to be involved in a movement for change, is my personal experience with mental health in India. My memory goes back to a perfectly fine Sunday afternoon, after lunch with my family, while I was lying on my bed when a melancholy set in and I pressed my face against the pillow and wished I would stop breathing. I tried to suffocate myself and failed, struggling to breath, tried yet again and gave up. I just wanted to end my life and didn’t know why. I felt very unusual and later I felt guilty for feeling that way.  I had a very close-knit family and was absolutely happy in all sense. I began experiencing similar melancholy a couple of other times too. A cloud began to form in my mind, which saddened me all the time. When I was crossing the road all I wanted was for a truck to come hit me and end my life. Sometimes when I was on the beach, I wished I would disappear into the ocean. I tried to brush these thoughts away, but they kept troubling me all the time. Death was a kind of fantasy. As a child, I couldn’t express this to anyone. Then as years passed my condition got worse.  

My family began to notice that something was wrong. I was either very depressed or would get manic in my behavior. They were not able to gauge my reactions and thought about all the possibilities. Then the umpteen visits to the physicians began and I had all kinds of physical ailments due to my mental state. I still remember, at one point my mother gave up and took me to an astrologer and a faith healer. Nothing worked, and finally my family decided to take me to a psychiatrist. My condition got really bad and was diagnosed as Clinical Depression and was given medication for it. My family convinced me that it’s not my fault and that it's an illness and that I ‘ll get better. I had relapses and was put on sedatives a couple of times.  

My family stood by me and cooperated with everything that the Psychiatrist decided, as all that they wanted was my betterment. My erratic behavior upset me and made me guilty all the time. Sometimes I began to believe if an evil spirit had got into me, because I couldn’t feel like myself, as if someone else was controlling me. I used to feel that my family didn’t deserve this pain and that I was almost like a curse to them. My condition worsened and the Psychiatrist decided to go ahead with electric convulsion therapy. There were times I used to feel so low that I used to tell my Dad that I wanted someone close to die, to justify my sorrow, and that one cannot feel so sad for no reason. Some other time I would have manic episodes where I would throw stuff or get violent. My family lived in fear, for me and kept every single thing of self-harm like a knife or any such thing away. Instead they showed me so much love and care. When I look back at my life, I feel I have gone through too much for a child of that age and my family went through even worse. But if it was not for this wonderful family that did everything for me to feel better and didn’t give up on me, I would be dead today. 

I was doing fine in school, but on and off the illness became a hindrance. I was on medications most of the time, few more ECTs, some hypnotic therapies, and one day my life changed. I was 19, walked back from school and gulped down a whole lot of painkillers and went to sleep. When my sisters came back from work I just realised what I had done and told them and was rushed to the hospital and had a stomach wash. When I was in the ICU with a tube down my nose and mouth into my stomach and saw my family through the glass door, I could see the pain in their eyes much bigger than what my illness was causing me. I wasn’t sure if I was going to live, and prayed that I should live, I wanted to be with my family. That day, I decided, I'm not going to fight this, instead embrace it and work around it. I began to live with it and made best use of my life when I was well. I did everything that I would have done if I weren’t unwell. I got through the best of schools, was into sports and other activities, got into great companies for jobs, got overseas offers for jobs and did well at work. It was only my family and very close friends who knew my condition.

When I came to the US, I visited a couple of Psychiatrists and was diagnosed with Bipolar II, or manic-depression, caused due a chemical imbalance in the brain. I realised I was not diagnosed right in India and that the medications might have not helped me. I was treated for the mood disorder and was given medication for depression as well as mood stabilisations along with occasional therapy, and a lifestyle to follow to keep it balanced. There are times when I feel so grandeur that I have an extreme sense of creativity and ability that is almost unreal. But now I understand that it is a part of my illness and tame it wherever needed and use that eccentricity to its best when needed. Some of my best works have been because of those manic periods. But there are days when I can’t get up from the bed and the sad cloud in my head pins me down, and chains me. Those days I just take it easy, slow down, because I know those days pass and I’ll see the sun again. I have my constant struggle and know that miracles don’t happen in this case and consider this as my share of struggle and I don’t let it enslave me. Whenever I have assumed that it has ended and when I have had a relapse, I have hit my lowest, because of the disappointment. I always remember my doctor’s words “It's like Diabetes and is a part of your chemical imbalance but can be controlled with medication and a balance in lifestyle” and do exactly that. Today I understand my illness, better than anyone else and lead a perfectly fine life dealing with it occasionally.

When I look back at life and what I see of myself today, I believe there is ‘hope’ for people like me, provided they have help and a family willing to help at the right time, before it gets too late. I was fortunate to have a family who could understand and seek help; partly because of being educated and mainly because of an attitude they had for life, which was unlike the society they lived in. I owe my life to them and to myself who developed a mind to understand things much before time and consider that as a reward for going through that mess. I know that everyone might not be fortunate enough to have someone help him or her or understand his or her problem. Moreover if I was diagnosed right, my condition wouldn’t be as bad as it was, and this was despite seeking mental health. What I see as a difference in the medical help in psychiatry back in India is the exposure. I can understand why this billion populated country has just less than 5000 professionals in this field. Partly because they don’t have enough people seeking that professional help. It is the attitude of the society. There might be a million other stories like mine who might not seek professional help due to the stigma of mental illness or even have known that they need help.   

I wish no other thirteen year old would go through what I went through and could get better much before I did, just by right diagnosis and an attitude to seek help. A whole lot of mental illnesses are treatable and can be under control, if we accept them and deal with it. If people like me share our stories to people who need help, we could help change attitudes. Mental illness, from what we see in Indian cinema since we were kids, was some crazy guy chained in some hospital which looked like a prison with crazy unkempt hair and looks as if he could harm anyone if the chains were off. That was an imprint of someone with a problem. If people see a problem they associate it with such imaginations. Things have changed quite a lot since then, but have a lot to improve yet. Only the elite, who are influenced by the west, go for psychotherapy, as it’s expensive for a common man.

Introducing mental health adaptations of the western society can help change the society in India as the society there is influenced by the west in so many other ways. This shouldn’t be difficult for the urban life there. Connecting socio-research groups and mental health associations could bring about a revolutionised change in adolescents and youth. Issues related to stress, anxiety and other disorders can be helped at a school-college level with their wellness departments specially addressing such issues, like how it is in America.  

For rural areas, there can be different approaches. Lack of education makes their approach to such ideas very difficult, and we can’t change this overnight. But we can always form an association of community health service, trained by psychotherapists and connect them to psychiatrists who could prescribe medication if needed.  

Acute problems like schizophrenia need extreme care and observation. A weekly visit to community centers could keep a check of such problems. While I researched about community health in rural India, I learnt that while I’m still thinking, someone is already doing it. My salute to people who take that plunge and make the change. One such non-profit organization is ‘The Mind foundation’. Their purpose is to provide high quality, cost-effective mental health care to every corner of rural India.4   They work on community education along with counseling and treatment via community mental healthcare workers. This just proves that people do have similar intentions for the society, but few really go ahead and do what they intended. I hope I have the strength to be one of them.

Just like how the west has embraced yoga and other forms of spiritual healing techniques originated from India, the western researched science and its medical techniques can facilitate this change to the society in India. Sometimes one doesn’t value what we have. It’s an irony that Yoga is embraced now by the youth in India as a fitness regime after the west adapted it. Till then, it was just an age-old technique adapted only by few. A therapy with a combination of such relaxation techniques along with medications that deal with chemical imbalance and psychotherapy, for the cognitive approach would be an ideal holistic approach for a general well being. I intend to raise funds in the United States for retreats or rehabilitation center which has no mental stigma attached to it (like some crazy prison where someone is chained and sedated), which facilitates a combination of psychiatric and psychotherapy along with age old spiritual and relaxation techniques like yoga and Ayurvedic massages.

 As a global community, it is time we help dispel myths about the prejudices related to this form of medical help and misperceptions about mental illness, and harness the healing power of holistic wellness. I believe there is a reason for everything, and may be my reason for what I went through is to empathize the pain of some others with similar under-recognized issues and help make a difference.

1http://www.pbs.org/newshour/bb/treating-mental-illness-medicine-religion-india/

2http://timesofindia.indiatimes.com/city/goa/1-in-5-persons-suffer-mental-illness/articleshow/23940462.cms

http://www.mindsfoundation.org/


*The author is a designer, and had written this piece as part of her classroom exercise in Parsons School of Design in NY. 

Related:

SSR’s tragic death: Are we missing the wood for the trees?
Not fair to label those with mental illness as 'weak'
Media, right-wing spew venom over Sushant Singh Rajput’s death

Mental health awareness in India

How stigma remains a hindrance to help

Image Courtesy:dailynurse.com

India, one of the fastest developing countries of today, is still stuck in a time-wrap, when it comes to social advancements and mental health. Social stigma still remains an obstacle to help Indians cope with mental illness. The attitude toward mental health in India is very different from the one in the West. It’s ‘something is wrong with you and it’s your fault,’ instead of ‘this is a medical problem and can be treated’. There's little awareness that it's a real illness. There's still a very deep stigma.

With a population of 1.3 billion people, India (in 2014) had 4,500 psychiatrists, compared to 50,000 in the U.S., about 4,500 in California alone. In India, about 100 million people were believed to suffer common mental disorders and millions more have more severe illnesses at that time. Ironically it is only in urban areas where medication and psychiatrists are available, but in rural areas medication is not available nor are psychiatrists. 1 

Most general physicians fail to diagnose psychiatric illness. A mentally ill patient displays symptoms, which superstitious people believe are paranormal. With the medical system in a mess and awareness about mental disorders lacking, faith healers and quacks are making hay. In rural areas of India, many villagers still believe that evil spirits cause mental illness. So-called therapy, conducted by witch doctors or family members, can include chaining up the mentally ill, chanting spells, poking them with pins, or beating them "to force the spirits out."

According to WHO countries like India devote less than 1% of their health budget to mental health compared to 10%, 12%, and 18% in other countries. But in recent years, the Indian government has increased budgets for psychiatric education and mental health awareness, seeking to curb a sharply rising suicide rate.2  Suicide is now the second-highest cause of death in India among those between the ages of 15 and 29, according to a recent study in the medical journal Lancet. The national suicide rate was about 16 per 100,000 people in 2010, compared to 12.4 per 100,000 in the United States, according to the national Centers for Disease Control and Prevention.3   

When it comes to matters of mental health, culture counts! Cultural perceptions about mental illness and treatment can vary. Some people in India perceive mental illness to be a curse caused by the evil eye or demonic spirits, others believe it is a sign of weakness, and yet others believe they are neuro-biological disorders. In America, most people believe that mental illnesses are neuro-biological disorders, while some believe it’s a sign of weakness. However, it is important to remember that America is a melting pot of immigrants whose perceptions about mental illness are shaped by their cultural legacies, while some cultures have their misperceptions of mental illness which can deter people from seeking lifesaving treatment and support.

"There's a big myth that everything psychiatrists do is so sophisticated and complicated. It scares a lot of people off. Demystifying mental health is important for the social acceptance of this medical help,” said K. Srinath Reddy, president of the Public Health Foundation of India, an organisation working to improve education, research, training and policy in public health. Unfortunately, society still stigmatizes those who suffer from routine psychiatric problems, so their treatment is either delayed or denied by their families or by themselves.  

In America, it is common for ads to be placed on a school notice board about free therapy or some brief psychotherapy research program or help groups saying “Are you Feeling Overwhelmed? “ or “vent with us, come in and talk to us about your experience”. These things make it so easy, so normal, for a student or an adolescent to deal with their ongoing stress or at the least relate to it. People’s minds are trained to seek help, and are taught to believe that it’s a problem and they can get help. Whereas in India there's a gradual increase in awareness that mental illness is a health problem, not a social or personal problem, but it's very gradual.

My reason for this quest, for wanting to be involved in a movement for change, is my personal experience with mental health in India. My memory goes back to a perfectly fine Sunday afternoon, after lunch with my family, while I was lying on my bed when a melancholy set in and I pressed my face against the pillow and wished I would stop breathing. I tried to suffocate myself and failed, struggling to breath, tried yet again and gave up. I just wanted to end my life and didn’t know why. I felt very unusual and later I felt guilty for feeling that way.  I had a very close-knit family and was absolutely happy in all sense. I began experiencing similar melancholy a couple of other times too. A cloud began to form in my mind, which saddened me all the time. When I was crossing the road all I wanted was for a truck to come hit me and end my life. Sometimes when I was on the beach, I wished I would disappear into the ocean. I tried to brush these thoughts away, but they kept troubling me all the time. Death was a kind of fantasy. As a child, I couldn’t express this to anyone. Then as years passed my condition got worse.  

My family began to notice that something was wrong. I was either very depressed or would get manic in my behavior. They were not able to gauge my reactions and thought about all the possibilities. Then the umpteen visits to the physicians began and I had all kinds of physical ailments due to my mental state. I still remember, at one point my mother gave up and took me to an astrologer and a faith healer. Nothing worked, and finally my family decided to take me to a psychiatrist. My condition got really bad and was diagnosed as Clinical Depression and was given medication for it. My family convinced me that it’s not my fault and that it's an illness and that I ‘ll get better. I had relapses and was put on sedatives a couple of times.  

My family stood by me and cooperated with everything that the Psychiatrist decided, as all that they wanted was my betterment. My erratic behavior upset me and made me guilty all the time. Sometimes I began to believe if an evil spirit had got into me, because I couldn’t feel like myself, as if someone else was controlling me. I used to feel that my family didn’t deserve this pain and that I was almost like a curse to them. My condition worsened and the Psychiatrist decided to go ahead with electric convulsion therapy. There were times I used to feel so low that I used to tell my Dad that I wanted someone close to die, to justify my sorrow, and that one cannot feel so sad for no reason. Some other time I would have manic episodes where I would throw stuff or get violent. My family lived in fear, for me and kept every single thing of self-harm like a knife or any such thing away. Instead they showed me so much love and care. When I look back at my life, I feel I have gone through too much for a child of that age and my family went through even worse. But if it was not for this wonderful family that did everything for me to feel better and didn’t give up on me, I would be dead today. 

I was doing fine in school, but on and off the illness became a hindrance. I was on medications most of the time, few more ECTs, some hypnotic therapies, and one day my life changed. I was 19, walked back from school and gulped down a whole lot of painkillers and went to sleep. When my sisters came back from work I just realised what I had done and told them and was rushed to the hospital and had a stomach wash. When I was in the ICU with a tube down my nose and mouth into my stomach and saw my family through the glass door, I could see the pain in their eyes much bigger than what my illness was causing me. I wasn’t sure if I was going to live, and prayed that I should live, I wanted to be with my family. That day, I decided, I'm not going to fight this, instead embrace it and work around it. I began to live with it and made best use of my life when I was well. I did everything that I would have done if I weren’t unwell. I got through the best of schools, was into sports and other activities, got into great companies for jobs, got overseas offers for jobs and did well at work. It was only my family and very close friends who knew my condition.

When I came to the US, I visited a couple of Psychiatrists and was diagnosed with Bipolar II, or manic-depression, caused due a chemical imbalance in the brain. I realised I was not diagnosed right in India and that the medications might have not helped me. I was treated for the mood disorder and was given medication for depression as well as mood stabilisations along with occasional therapy, and a lifestyle to follow to keep it balanced. There are times when I feel so grandeur that I have an extreme sense of creativity and ability that is almost unreal. But now I understand that it is a part of my illness and tame it wherever needed and use that eccentricity to its best when needed. Some of my best works have been because of those manic periods. But there are days when I can’t get up from the bed and the sad cloud in my head pins me down, and chains me. Those days I just take it easy, slow down, because I know those days pass and I’ll see the sun again. I have my constant struggle and know that miracles don’t happen in this case and consider this as my share of struggle and I don’t let it enslave me. Whenever I have assumed that it has ended and when I have had a relapse, I have hit my lowest, because of the disappointment. I always remember my doctor’s words “It's like Diabetes and is a part of your chemical imbalance but can be controlled with medication and a balance in lifestyle” and do exactly that. Today I understand my illness, better than anyone else and lead a perfectly fine life dealing with it occasionally.

When I look back at life and what I see of myself today, I believe there is ‘hope’ for people like me, provided they have help and a family willing to help at the right time, before it gets too late. I was fortunate to have a family who could understand and seek help; partly because of being educated and mainly because of an attitude they had for life, which was unlike the society they lived in. I owe my life to them and to myself who developed a mind to understand things much before time and consider that as a reward for going through that mess. I know that everyone might not be fortunate enough to have someone help him or her or understand his or her problem. Moreover if I was diagnosed right, my condition wouldn’t be as bad as it was, and this was despite seeking mental health. What I see as a difference in the medical help in psychiatry back in India is the exposure. I can understand why this billion populated country has just less than 5000 professionals in this field. Partly because they don’t have enough people seeking that professional help. It is the attitude of the society. There might be a million other stories like mine who might not seek professional help due to the stigma of mental illness or even have known that they need help.   

I wish no other thirteen year old would go through what I went through and could get better much before I did, just by right diagnosis and an attitude to seek help. A whole lot of mental illnesses are treatable and can be under control, if we accept them and deal with it. If people like me share our stories to people who need help, we could help change attitudes. Mental illness, from what we see in Indian cinema since we were kids, was some crazy guy chained in some hospital which looked like a prison with crazy unkempt hair and looks as if he could harm anyone if the chains were off. That was an imprint of someone with a problem. If people see a problem they associate it with such imaginations. Things have changed quite a lot since then, but have a lot to improve yet. Only the elite, who are influenced by the west, go for psychotherapy, as it’s expensive for a common man.

Introducing mental health adaptations of the western society can help change the society in India as the society there is influenced by the west in so many other ways. This shouldn’t be difficult for the urban life there. Connecting socio-research groups and mental health associations could bring about a revolutionised change in adolescents and youth. Issues related to stress, anxiety and other disorders can be helped at a school-college level with their wellness departments specially addressing such issues, like how it is in America.  

For rural areas, there can be different approaches. Lack of education makes their approach to such ideas very difficult, and we can’t change this overnight. But we can always form an association of community health service, trained by psychotherapists and connect them to psychiatrists who could prescribe medication if needed.  

Acute problems like schizophrenia need extreme care and observation. A weekly visit to community centers could keep a check of such problems. While I researched about community health in rural India, I learnt that while I’m still thinking, someone is already doing it. My salute to people who take that plunge and make the change. One such non-profit organization is ‘The Mind foundation’. Their purpose is to provide high quality, cost-effective mental health care to every corner of rural India.4   They work on community education along with counseling and treatment via community mental healthcare workers. This just proves that people do have similar intentions for the society, but few really go ahead and do what they intended. I hope I have the strength to be one of them.

Just like how the west has embraced yoga and other forms of spiritual healing techniques originated from India, the western researched science and its medical techniques can facilitate this change to the society in India. Sometimes one doesn’t value what we have. It’s an irony that Yoga is embraced now by the youth in India as a fitness regime after the west adapted it. Till then, it was just an age-old technique adapted only by few. A therapy with a combination of such relaxation techniques along with medications that deal with chemical imbalance and psychotherapy, for the cognitive approach would be an ideal holistic approach for a general well being. I intend to raise funds in the United States for retreats or rehabilitation center which has no mental stigma attached to it (like some crazy prison where someone is chained and sedated), which facilitates a combination of psychiatric and psychotherapy along with age old spiritual and relaxation techniques like yoga and Ayurvedic massages.

 As a global community, it is time we help dispel myths about the prejudices related to this form of medical help and misperceptions about mental illness, and harness the healing power of holistic wellness. I believe there is a reason for everything, and may be my reason for what I went through is to empathize the pain of some others with similar under-recognized issues and help make a difference.

1http://www.pbs.org/newshour/bb/treating-mental-illness-medicine-religion-india/

2http://timesofindia.indiatimes.com/city/goa/1-in-5-persons-suffer-mental-illness/articleshow/23940462.cms

http://www.mindsfoundation.org/


*The author is a designer, and had written this piece as part of her classroom exercise in Parsons School of Design in NY. 

Related:

SSR’s tragic death: Are we missing the wood for the trees?
Not fair to label those with mental illness as 'weak'
Media, right-wing spew venom over Sushant Singh Rajput’s death

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