Looking in from the outside: In denial of mental illness
The fear of isolation reinforces the burden of stigma on patients suffering from mental health problems Photograph: (Others)
Growing up in a family with psychiatrists is anything but ordinary. Once I moved past my fears as an adolescent of being psycho-analysed at the dinner table, I realised that I was privy to some very intriguing interactions beyond what otherwise seemed run-of-the-mill.
One such interaction took place with a gentleman I met a few months ago in the hospital sitting area. A few minutes into our conversation, he shared that it was usually a struggle for him to arrive on time for his appointments. His wife, he explained, insisted he park his car a few blocks away from the psychiatric hospital, and pace around the entrance waiting for the right opportunity to enter, lest he is recognised by someone he may know.
In another case, a husband and wife were in marital discord. The husband’s chief complaint against the wife had been her unpredictable holidaying at her parents’ house outside India. He found out years later, much to his surprise, that she had in fact not been traveling, but staying in the same city as him – availing treatment for an anxiety- related disorder. She had been afraid to share her troubles with him.
Then there was the baba. A spiritual teacher and healer with a considerable following, he had gained the reputation of taming even the severest of mental illnesses through mystical means. Yet, as he later shared with his followers, when he himself battled depression, he would pay weekly visits to our house, ostensibly to give his blessings, and leave with a prescription. I’m told he no longer offers treatment for psychiatric disorders.
Studies today estimate, conservatively, that at least 2 crore Indians suffer from mental health issues, and 1 in 5 Indians will require some form of professional care for emotional or behavioural difficulties.
Yet, a recent study found that although mental health awareness activities had larger footprints in metro cities in India, even educated populations in such cities underestimate the prevalence and frequency of mental health disorders. An astonishing 89 per cent felt mental illnesses made individuals vulnerable to ridicule and discrimination, and 63 per cent doubted whether such a person could even lead a life of dignity. The fear of isolation in a crowd, being made to feel like an anomaly, re-inforces the burden of stigma that even common mental health problems carry.
The fear of isolation is perhaps the biggest obstacle to adequate help from being sought and holds the person back from leading a life of full dignity. Perhaps not surprisingly then, the government itself estimates that 90 per cent people suffering from common mental health issues do not receive any treatment.
The Constitution of India guarantees the protection of life and personal liberty, including the right to live with human dignity, for every individual to grow in every aspect – physical, mental and intellectual. However, it is our failure to overcome simple social fallacies that denies even this most fundamental right of crores of vulnerable people in need of medical treatment.
The study referred to earlier found that 68 per cent people blamed popular culture, in particular, cinemas for irresponsibly promoting biases and prejudices against persons with mental illness. They felt the most identifiable portrayal of a person suffering from a mental illness was that of a dangerous and violent person who was unsociable and eccentric, requiring ‘shock therapy’ for treatment while being ‘locked up’ in an asylum. Obviously, for many reasons, this depiction is incorrect.
A former classmate, who battled depression, used to remark how the Indian society demanded unnaturally ‘perfect’ public figures, and so one had to look outside India for inspiration from public personalities who had overcome mental illnesses. Even my father told me how he would encourage prominent public figures – actors, sportspersons, musicians, politicians - who met him professionally to consider speaking publicly when they deemed fit about their illness and recovery. However, most hesitated fearing public reactions.
Prominent global personalities like Leonardo DiCaprio, David Beckham, Gwyneth Paltrow, Brad Pitt, Justin Bieber, JK Rowling and Ellen Degeneres, to name just a few, have spoken about their battles with mental illness. However, there has been far less cause for public debate in India with virtually no role model to navigate it.
This is why I am elated by what Deepika Padukone has set out to achieve. With her publicly speaking about her depression, we have now seen another handful of public figures also share their stories.
The timing could have been no better. It is no longer possible to continue ignoring mental health as it also comes at a cost. The global community is waking up to the overwhelming economics of doing so, and is boosting their budget expenditures to bolster public mental healthcare and even supporting health service providers outside the public health systems. India, however, still seems ill-prepared for this challenge as well as to address the loss to its economy estimated to be $240 billion annually between now and 2030.
The field of mental health is also abuzz for another reason. Certain mental health reforms introduced in the Mental Health Care Bill, 2013 were recently passed by the Rajya Sabha. However, the reforms require extensive governmental investments, without earmarking sources for such investments. Financial impracticality had led to similar ambitious proposals under the National Mental Health Programme (1982) and other national health policies over the past 33 years stalling.
Over the past decade, grappling with problems of a developing country, India has regularly been unable to devote in excess of approx. 1 per cent of its GDP for healthcare. It is imperative for policy-making to be innovative, and acknowledge the past failures, and perhaps even evolve creative means of raising funds to be sustainable.
Besides, it is strongly felt by many that the reforms adopt certain untested concepts, particularly, the individual rights based approach. Modeled on western systems, this may not be well-suited locally, where a large burden of health care falls on families and caregivers as social security norms are lacking and there is a dearth of state-supported facilities. Key national associations of mental health professionals critically observe that, stakeholders in the mental health services who would have the most regular interface with the reformed laws felt were almost entirely excluded from the process of formulating the reforms.
Nevertheless, I am optimistic. With the mental health policy and legislation reforms, we stand at the crossroads with an intent to radically change the mental health landscape of the country that has one of the largest and most ignored populations of people battling a silent epidemic. For far too long those associated with this field have been left to overcome challenges by themselves, marching along while counting small victories and losses every day.
At a time when I had just begun to fathom the scale of the mental health crisis in the country, a friend put things in perspective. She said – ‘
To live with a mental illness in this country is to live a double life, filled with contradictions. I may be the one suffering from an illness, but it is everyone else who seems to be in denial.
In denial, indeed.