Undermining mental health
“Mental Health”, what image do you get when you think of this word? Can you put the image in words? Perhaps not. Let me breakdown the kind of image that is formed in your mind and try to understand why we are getting all of this wrong. These are the three images (broadly) which come up in our mind when we as Indians talk about mental health:
- Mental Hospitals, similar to jails and we assume the person is insane, which mostly is not the case. You know it’s a bad place to be in when kids are told by their parents that if you don’t behave well, you will end up in a mental hospital. There is a stigma around the concept of mental hospitals and getting help from psychiatrists.
- Suicides, so essentially all the suicide prevention services.
- And the worst of all, “Only weak go through depression”. No one accepts that at some point in their lives, they were depressed as well. Hence the attitude of, “It’s all well, doesn’t matter much” attitude.
Now, I get it. Why we feel exposing our mental health status in social groups is not that good option. This image comes in the top 3 images results when we search for mental hospitals in India :
This is bad, this is seriously very bad. In this COVID19 world, where I am afraid of going to institutional quarantine because the food is bad, and the toilets are not properly cleaned; I am definitely afraid of going to a place whose first google image search looks like this. We as a country have to reconsider a few things. And this is not just about government. We as a society have to change our thinking.
National Mental Health Program 1982
Government of India launched NATIONAL MENTAL HEALTH PROGRAMME (NMHP) in 1982. Yes, 1982. In the government’s own terms, these are the objectives of the program:
- To ensure the availability and accessibility of minimum mental healthcare for all in the foreseeable future, particularly to the most vulnerable and underprivileged sections of the population;
- To encourage the application of mental health knowledge in general healthcare and in social development; and
- To promote community participation in the mental health service development and to stimulate efforts towards self-help in the community.
Later the GOI launched another program, called the District Mental Health Program (DMHP) in 1996. This was the part of the 9th 5 Year Plan of the government. This had the following objectives:
- Early detection & treatment.
- Training: imparting short term training to general physicians for diagnosis and treatment of common mental illnesses with a limited number of drugs under the guidance of specialists. Health workers are being trained in identifying mentally ill persons.
- IEC: Public awareness generation.
- Monitoring: the purpose is for simple Record Keeping.
38 years down the line, we no longer have five-year plans as the Planning Commission was dissolved and a NITI Ayog was formed. Is there any spectacular change in the situation? Maybe a few additions to the tally of Mental Hospitals in the country. Otherwise? No.
There are two broad reasons why we have made no progress in the last 38 years despite knowing that the problem is real and very much exists.
1) Public Perception : We have never acknowledged the existence of these problems. We get a sneeze and rush to an Otolaryngologist, we feel some pain in the chest and rush to a Cardiologist. We feel depressed, we shy away. A lot of us have PTSD (Post-traumatic stress disorder), depression, OCD (Obsessive-compulsive disorder), Generalised anxiety disorder, and Panic disorder. But either we don’t know about it. If we do, we don’t acknowledge it. If we do acknowledge, we never seek help. Because then, what will people say? Will someone marry me? What will happen to my family’s reputation? We are afraid of what our neighbors will say more than anything. Another very big problem is no one knows whom to approach. But we will come to that later.
2) Gap in government understanding : There is a very big flaw in the basic understanding of mental health when it comes to the government and their response. They say and I quote,
It is estimated that 6-7 % of the population suffers from mental disorders.
This is where the whole set of problems lie. This number is much higher, if this were true only 6-7 people out of every 100 people I meet are supposed to have some mental condition. But the truth is miles apart. My estimate makes this number around 35-40. Everyone is facing some mental condition these days, and in the Post-COVID19 world, this number is going to rise.
The World Bank report (1993) revealed that the Disability Adjusted Life Year (DALY) loss due to neuropsychiatric disorder is much higher than diarrhea, malaria, worm infestations, and tuberculosis if taken individually. Together these disorders account for 12% of the global burden of disease (GBD) and an analysis of trends indicates this will increase to 15% by 2020 (World Health Report, 2001).
Again, this explains too much. The government is focusing on major mental disorders and leaving people with common mental disorders out of the equation. They also write:
One in four families is likely to have at least one member with a behavioral or mental disorder (WHO 2001). These families not only provide physical and emotional support but also bear the negative impact of stigma and discrimination. Most of them (>90%) remain untreated.
Please note that while also quoting them, I fixed a few spelling mistakes which show how serious they are. And they claim that 90% of the people with major mental issues remain untreated. This number doesn’t take into account those people who face common depression and never talk about it.
Therapy and Counselling
If you follow enough western TV shows and movies, every other character at some point in their life consider going to a therapist or participate in communities where people talk and get things out. We don’t have that in India. I know, most of you will say, “Hey, you had GCS in IIT Mandi”. Now I am from one of those very rare IITs, where the suicide rate is almost 0. But that does not mean students are not depressed, there are multiple factors which drive them away from such decisions, one being the Nature and serene beauty of the campus. The GCS, or Guidance and Counselling Service of IIT Mandi is active only during student admissions. There is only one professional counselor and I have seen the client confidentiality being broken in first hand. In my 4 years of B.Tech., I was depressed, had very difficult times too, but never even considered approaching GCS with my problems. And that is because of a lack of Trust.
Now that I step out of my University, I frankly don’t know whom to approach in such a problem. We as a society have produced so many Engineers, Surgeons, Lawyers. But Therapists? very few. There is a rise in these kinds of practices, but that is not enough. Companies such as Calm are coming up. But the bridge is broken. And then we have Bollywood, where every other person with a mental disorder is either a killer, maniac or a comic character :
The other character in this movie also had Dissociative Identity Disorder, or as they try to portray it as a Ghost or whatever. This article also talks about the same issue where Bollywood stereotypes these rather sensitive mental health issues.
My personal experience
I got into IIT with zero programming knowledge. I had no idea of what C/HTML is. A lot of people were already ahead of me in terms of this. Some of my batchmates also took up all this in their school days. Already with a sense of inferiority, and being in the Civil Engineering Branch, I started to learn computer science.
I later changed my branch to Electrical Engineering. This looked fine but looking at the placement statistics of IIT Mandi Electrical, I was a bit concerned about what was going to happen in the future. Now as this all was piling up on me, I entered my sophomore year, and a lot of students from the University were trying hard to get selected in GSoC. IIT Mandi did very well that year, we were among the world’s top 10 Universities by the number of students selected. And after working 2 months on a project, I was not selected. Before the selections happened, I already made 8-9 meaningful Pull Requests to the project and it was very difficult for me to accept the fact that I did not get selected.
I still remember, I was in Vishal Anand’s room and we were studying for the Computer Organization exam. At around 11 PM, I came to know that I wasn’t selected and I cried a lot. Honestly speaking, I did put in a lot of effort for that GSoC and worked literally day and night. I have still not recovered from that trauma, and often use it as a tool to make myself work.
At this point, even my parents knew that it was a big blow. I got a call from my senior Ayush Yadav, that night. He told me that nothing is over. I can still do a lot of things etc. Maybe talking to people helped, but no one actually understood what I was going through. I lost all the faith in myself. I still don’t have the faith that I can achieve something, and usually, I don’t. I often don’t apply to programs as I feel, why would they select such a person.
That one GSoC was very important as in the subsequent years, I never got a chance to participate in the program again. I hope I will someday forget this, someday looking at my GitHub profile won’t remind me of that day.
Connecting the dots
A lot of students who commit suicides is because they fail to achieve something. A lot of times it is also because of their relationships and projects. They don’t get good jobs etc.
Although I don’t follow Steve Jobs a lot, there is a speech made by him which makes me feel much better and makes a lot of sense when I think about my life and evaluate it:
Connecting the dots
This was a part of Steve Jobs’ Commencement address on June 12, 2005, at Stanford University.
You can’t connect the dots looking forward, you can only connect them looking backward. So, you have to trust that the dots will somehow connect in the future. You have to trust in something. Your gut, destiny, life, karma, whatever. This approach has never let me down, and it has made all the difference in my life.
You can find multiple stories of people inspired by this speech. Like this. Honestly, I did not even know about this speech before my final year. And now, it is a part of my life.
Embrace the beautiful life you have. Go, seek help if you feel its too difficult for you to handle these problems, we are not perfect, neither we are capable of solving all our problems by ourselves. Because if it were the case, we would never have talked to each other. We would never need a lawyer to represent us in courts, we would never need a plumber to fix our sink, we would never need a prime minister to run our country. We need help from time to time, and it is best when you seek help from professionals who understand the problem. Similarly, while we go to the gym for physical health, we need to do something for our mental health too. Meditation, Music anything.
If you would like to have a conversation about this, maybe understand my point better, drop me an email (firstname.lastname@example.org). If you felt a little better after reading this, if you’d like to join hands in tackling this problem, or if you just want your story to be heard. I am all ears, and I am all in. Please feel free to schedule a call with me and we will definitely talk.
Now is the time when we wake up, now is the time when we rise!