[Disclaimer: The opinions and experiences expressed within this article belong to the author alone. Having struggled with depression himself, this is in no way a reflection of the work Indian counsellors and psychiatrists are doing on the whole. Seeking expert counselor or psychiatric therapy remains the best course of action for any individual suffering from depression.]
[Editor's Note--When I went through the first draft of this article, I was surprised to find myself wanting to strip more of the personal bits down and focus on the issue of mental health through a broader spectrum lens. It would make for easier reading, I rationalized. People are less able to poke holes in objectivities and it was important to portray Mental Health in an 'objective' light if we wanted people to grapple with the reality of its existence. Until I realized this was exactly the root of the problem we face in India. The very nature of mental afflictions makes us uncomfortable when packaged in a such a personal manner. It's difficult to listen to a person's struggle with depression because the knee-jerk reaction is to tell them to 'get over it.' Move on the way we all do when we're sad but the truth is, there's no acceptance without allowing the subjectivities along with the objectivities in this discourse. They're every bit as real as the physical ailments we allow sympathy over so it's time to win the most important battle--removing the stigma associated with mental affliction--before we win the war. Here's Devang Pathak with an incredibly brave, personal story on his own struggles with depression. Of course, depression is only one of the many such mental illnesses that people can be afflicted with but watch this space for more informative articles around Mental Health in India.]
“If it’s a place, you get out of it. If it’s a person, you stay away from them.But what do you do when the problem is you, yourself?”
The obvious epiphany stated above is one I had while trying to apologise to someone for lashing out on them due to no fault of their own. These realisations are a frequent fare when you are forced to play your own therapist while combating a stifled sense of existence where melancholy is routine and normalcy a welcome break. While I am not qualified enough for a self-diagnosis, it was safe for me to assume then that the depression was back.
The recent revelation by Deepika Padukone has bought depression in India into the mainstream spotlight in an atypical fashion where the mainstream wakes up to something when a popular figure or event triggers it . While her openness about the struggle with depression and the initiative taken with her foundation is commendable, the fact remains that this is not a new problem for India but a reflection of a serious concern raised years ago. A 2011 study claimed that there are over 4 crore Indians afflicted with Mental Health issues of some nature and only 4000 mental health experts available to a population of 1 billion. A WHO study in 2011 found Indians to be among the most depressed in the world with 9% of the people having an extended period of depression within their lifetime and 36% suffering from Major Depressive Episodes (MDE). MDE is such a severe bout of depression, that planned suicide is highest among those who suffer from MDE, a fact which is reflected in 2012. Another WHO estimate puts the number of suicides in the country in 2012 at 258,075, the highest in the world, with youngsters between the age of 15-29 having the highest rates of suicide with 35.5 per 100,000. While the study said that mental disorders are a relatively smaller cause in India behind the deaths, responsible only for 60% of the suicides, one can only wonder how accurate the causes can be estimated in the country where mental disorders and depression are hid under the rug or embraced with skepticism, a fact that I can personally vouch for.
Something Is Wrong
“They cannot cry in public”, my relatives from London noted while describing the funeral procession of Lady Diana. The princes were expected to be stoic and not show emotions in the public while they mourned their mother’s death. The first reaction was of surprise, after all Indian funerals are regarded as a solemn affair where even men can express their emotions. But when I scratch beneath the surface now, propensity to emote was never big in my family anyways.
The family dinners and lunches would have silence filling small talk where informational events such as upcoming exams, developments at work, and updates on a sick relative will be reported. A dearth of topics seem to be cured by making observations on strangers such as the neighbours, servants and political leaders but never does “How are you feeling today?” echo on the table. I would be tempted to brand it as my parents’ fault but then I would see the same behaviour when we would meet our extended family. There would be jokes and information passed around freely, but barring few instances, emotions were never openly expressed by anyone in the family. The perceived aloofness seeps through, gradually becoming a driving part of your personality. The repression becomes so severe over time that it spurs a denial in you, even when you wake up in the middle of the night with a panic attack.
The practiced repression and ignorance of below-the-iceberg emotions of my sub-conscious continued successfully until I found myself sitting at my desk on the second day at a startup. Two things became really clear to me- I wanted to do nothing else in the 16 hours required for daily consciousness but write and I needed to talk to someone. Then came the fun ( humor is melancholy’s best defense weapon) part – justifying your need for therapy to Indians.
The first reaction is of obvious skepticism where you parents are not convinced that their child needs this. The silent questions being asked are Why is this happening? What is the reason behind it? to which the obvious reply is also the most natural, “I don’t know, and this why I said I needed help”. What makes it even worse is when assumptions and generalizations are taken as answers even without confirmation from the source itself–in this case, me. Even my closest friends seemed to be shocked about my decision- “You can talk to us. No need to pay someone to listen to you”- perhaps a naive observation of how therapy works, but regrettably, it turned out to be true.
Do I Have To Lie Down and Talk?
I enter the psychiatrist’s office with no prior personal experience or knowledge of how this works save for the American shows and sitcoms I had seen. I was directed to one of the counsellors who listens to me and then offers a test which will determine my mental state. While I was hesitant in deeming it depression, the prospect of the test would give me a certain answer and more importantly, a validation for my stand (because Indian parents will believe anything as long as it’s on a piece of paper from a credible source – be it your teacher,doctor or a counsellor). Thankfully, the results didn’t disappoint as I was found to be clinically depressed in a mild manner, almost borderline. Ironically, I felt relieved as I could take it to my parents and friends and say -“Look, there is something inexplicably wrong with me. Accept it now, please.”
The psychiatrist finally met me after the tests for all of but 7 minutes if I can remember correctly. One of her passing remarks in taking the gist of my case was “Even I have to do things I don’t like in this job.” Did my therapist pass a premature judgement about me? I was too vulnerable then to fixate on the statement as she prescribed me pills to help me with my daily mood and one for panic attacks and ‘over-thinking’.
I had to come twice a week to talk to my counsellor where each day would be based on some topic to get to the bottom of the single or multiple reasons for my ‘slump’. The topics would range from the ‘bad breakup’ to ‘issues with my parents’ to ‘prospective career opportunities’ to ‘expectations from my friends.’ The session would have me dominating the conversation for almost 50 minutes with her nudging me towards certain reflections or banalities. While I would describe my views and experiences, I had the tendency to correct and censure myself – a fact I believe any good counselor is supposed to detect and resist. I would accept the fallacy of a few of my statements and thoughts but that was the full extent of any investigations or revelations in the sessions. While talk therapy is supposed to be about listening, it’s also supposed to help one look at things which one hates to discuss or admit. A monumental session was supposed to be one where my parents would be called in and told about my progress as well as more to help me resolve my issues with them. My father bluntly states,“We just want him to be happy and get his career set.” I realised that while I harboured no specific outcome or result from this exercise, he certainly did. When I was asked if I wanted to say anything, I muffled it with smile, a few words and civility as the fear of being honest and misunderstood took over again. As my parents and I departed from the clinic, I sat with a smile and sense of ease on the surface while my conscience told me like the Beatles – Nothing’s going to change my world.
“Sometimes we take action. Sometimes we take pills.”
The easy access to anti-depressants in a heavily regulated country like India would seem like an exciting proposition for anyone-but they would leave my brain dysfunctional and foggy all day. While the emergency pills were effective and even requisite, the daily pills would leave me unable to think or articulate clearly. My ability to analyse and write would be seriously hampered. I would be happy and calm for the first time in days thanks to them–just not myself which preferred his brain to think and analyse freely to write. After almost six months of therapy, I walked away- not just because of the futility of the sessions, the failure to bring a resolution and identification of my problem or the medicines which would hinder my writing – but also because of the financial cost of seeking therapy. Each weekly session has a fixed charge with frequent interruptions while the appointment with the psychiatrist would run to thousands, just to get her to spare a few minutes talking to me or my parents. Ultimately, my friend’s statement proved to be right- I was literally paying someone else to listen to me and nothing more.
Self-therapy and the ever-elusive “Support system.”
I cannot say the therapy was a complete mistake. Interestingly, “The World Health Organisation says the number of suicides in India could be reduced by at least 1/4th if counselling is given on time. That is one in four lives could be saved, but there’s an alarming shortage of trained psychiatrists.” I did have some final, credible proof that the gnawing sadness I felt at the end of my graduation was not a passing mood or phase, but more importantly, I learned to be honest about my feelings. I did feel genuinely better by the time I ended the therapy – a result of time I believe more than the absent efforts on either my own or the counsellor’s part. My parents would now try to coax me again and again to get a job, reiterating “What was the point of the therapy? What was the end result?” a subtle implication that I was using my mental and emotional issues as an excuse to be lazy and shirk my adulthood (and maybe they were right too). I would have had to quickly submit myself to another round of therapy had it not been for my friends, who anchored me away from the dark place multiple times.
“Don’t take this the wrong way, but I love you and I think you are awesome,” said a friend privy to my depression, to distract me when I told her about my parents’ pressure to find a job. I had kept my therapy a secret from my larger ‘hangout’ group for multiple reasons. They were people who could never handle morbid emotions well–always opting for the general politeness, fun and irreverence, but also because I hated being negative gossip. I am viewed as the ‘difficult‘ person who is busy pointing out flaws in the way few individuals or the group as a whole functions and busy being offended or angry about ‘trivial’ things. Add a ‘he is so negative he had to go see a therapist’ to that mix and you are viewed as a ‘sensitive’ man- something the world is quick to dismiss as a weak entity. Thankfully, I had a few close friends I could rely on.
I would tell them anything and everything I felt – from the stress I felt for no apparent reason to the self- realizations I would have about my own flaws. While they would reciprocate with due kindness and sensitivity, I realized that this could not go on for long. My friends were making their first foray into adulthood and the demanding, busy lives they lived as working professionals or post-graduate students didn’t give them the patience or the time to deal with me or my issues. You don’t want to come back home and spend an hour convincing someone that they matter every single day and not to harbour the ‘dark suicidal thoughts’. Besides, the availability of time, there was also the obvious – they could not possibly fathom what I was going through.
If I were to rationalize any reason for my being upset, it would become a topical debate- ‘Everyone has to go through it’,’ all parents are like that’ and ‘stop being so negative’ would become the generic advice I became most used to having thrown my way, even without them realizing that I still had a lot more to say, which might change the core issue at hand. I would undertake exhaustive measures to try and make them understand how they could help me – from sending out stories, quotes and articles to songs like Lucinda Williams ‘Are You Alright?’ or even texting them to switch on the television and watch Satyamev Jayate’s Depression in India episode. While I absolve them of any intentional ill-will or apathy, I do wish they could give me more patience in listening, even if not their time. There seems to be so much for me to say and not enough patience in people, that when I was a part of a qualitative study recently, I ended up digressing with details about my life rather than the views on a particular topic.
[Watch the Satyamev Jayate episode on 'Nurturing Mental Health' in India below]
How am I now? Could complain but I don’t. I am learning to survive it a day at a time. There are periods with extreme bouts of melancholy, with or without any reason, where I feel like stagnating in bed all day and indulging in extreme self-pity. Then there are days where I can deal with life while keeping it all simmering dangerously below the surface. I do laugh frequently but the heartfelt smiles are more scarce and ephemeral.
Stop telling them to “Get Over It”
But perhaps the greatest realization through this entire experience has been broadening my own spectrums a bit–understanding that i’m far from a unique case in this country. WHO has said that Depression will be the second most prevalent medical condition in the world by 2020. If one ties in that with the data presented at the beginning of the article, this is one problem India simply can’t afford ignore. The most frustrating part for anyone suffering from depression lies in the paucity of understanding and conversations in the mainstream about the condition. I find it highly offensive that an episode of Satyamev Jayate or the revelation of a top star’s struggle with depression is what defines our concern levels (the first draft of this article was ready days before Deepika’s NDTV appearance without any starry mention) sometimes not even in the correct way. While many articles were written about Deepika’s first revelation and scores more will be written again, a myopic view is being propagated by a few of them where it’s being viewed simply as a show business problem and the “Bollywood” angle to it.
Depression and scores of other mental illnesses are real and universal. While they do differ in severity and treatment, each of them are disruptive enough in a way to cripple a person’s life . A genuine concern which exacerbates the Indian situation besides the silence of our society is that while I have access to psychiatrists and counselors, what about the people in the country who face ten times the daunting mental stress that I do and have no access to such help due to the high costs? Despite being named one of the most depressed countries in the world, why aren’t we investing in a universal mental health policy?
While we wait on a policy initiative, there is still something each of us could do – listen and accept. If you ever see a loved one or a friend trying to reach out for help, don’t hastily dismiss them with banalities of ‘Get over it’,'Be positive’ or the presumptuous ‘You are fine’. The simplest solution lies in listening and getting them any help they could require. While my first experience at seeking therapy was not a positive one, I am certain I would visit a counsellor or psychiatrist if I find myself in a similar mental situation again, without any hesitation, just as I would visit a general physician for an infection or injury.
There is no shame or ‘weakness’ in having depression. It’s an illness with just a different form of cure.
Words: Devang Pathak
[Disclaimer: The opinions expressed within this article are the personal opinions and experiences of the author's alone. Having struggled with depression himself, this is in no way a reflection of the work Indian counsellors and psychiatrists are doing on the whole. Seeking expert counselor or psychiatric therapy remains the best course of action for any individual suffering from depression.]