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How Difficult Is It To Start a Conversation About Mental Health In An Indian Home?

10/10/2015 7:12 AM IST | Updated 15/07/2016 8:25 AM IST
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MANPREET ROMANA via Getty Images
TO GO WITH HEALTH-INDIA-SOCIETY BY YASMEEN MOHIUDDIN Members of Sanjali relax at the Sanjali daycare rehabilitation centre for mental illnesses in New Delhi on May 28, 2009. Most of the patients at the Sanjali rehabilitation centre in New Delhi cannot explain why they are there or what their lives were like before chronic mental illness struck. But they are among the lucky few in India to receive regular treatment in a country where discussing mental health carries a huge stigma and mental hospitals are often strict and frightening institutions. Experts say around 20 million Indians are afflicted with serious mental disorders, and most are hidden from public view by their families. Treatment normally ranges from temple visits to sessions with informal faith healers or more extreme 'cures' involving everything from witchcraft to iron chains. AFP PHOTO/ Manpreet ROMANA (Photo credit should read MANPREET ROMANA/AFP/Getty Images)

"Doctor bolche, depression o ache (doctor says she has depression too)," my mother sighed as she intently thickened the lines of the words 'January 2009' scribbled on top of a white manila envelope with a red ball-point pen. 'January 2009' would then sit on the top of the stack of stiff, white envelopes in the corner of our steel almirah. Over the years, the little pillars of envelopes had shoved my school scrapbooks, my bother's art books out of the shelf - my grandmother had been unwell for really, really long. My mother reserved one Sunday every month to re-arrange, compare and comment on her medical files - we had one new one every other month. And my grandmother would sit in one corner of the bed, her face buried in the day's English tabloid - her refuge in those inclement Sundays, which would inevitably see one fried, or sweet, or milky staple of Bengali homes struck out of her 'can eat' list.

However, this Sunday was going to be different. "Depression?," she gawked, her eyes twinkling, "Taale ki pepe siddho bondho (Does that mean you'll stop feeding me boiled papayas)?"

The room crackled with laughter - my mother's, my grandmother's and mine. Phew, we thought, no new problem this time. Depression, after all, didn't qualify as a disorder or a health challenge in our scheme of things. The manila envelope went into the shelf. And the lightly fried rohu fish - that my grandmother had imagined that week's casualty would be - continued to be a legitimate food item for her.

All was well.

Another Sunday, six years later, over two years after my grandmother's death, I have a dozen windows open on my laptop. Pretty much everything can be a sign of depression, I mutter in confusion going over website after website which have listed 'alarm bells', 'alarming signs', 'symptoms which should concern you' about depression. Figuring that my attempt at Google diagnosis may not work, I decide to have a conversation. My mother has been unwell, I have been living in another city and recently a bunch of health complications have left her slightly rattled. "This is old age setting in," she had said the other day, making it sound pretty much like an alien attack.

But here's the rider - I can't talk to her. I make three calls through the day, long, winding, hour-long ones. By the end of the day, we have moaned at my cook's infatuation with chilli powder, my mother's wrongful assumption that heavily bearded men are simply lazy men, the sarees that need new blouses, my father's latest breakthrough in making our dog braver in the face of crows, the neighbour's noisy birds, the no-refusal taxis in Kolkata who refuse every customer, my brother's deep love for Salman Khan and the prospect of me trying to walk on heels taller than two inches.

And I have not been able to say it, one simple line. "Maa, do you want to see a psychiatrist?"

I try to get my brother, who lives with my parents, to be fellow conspirator.

"How can we take Maa to a psychiatrist?", I text him on WhatsApp.

After an hour, he replies. "??????????"

That's a conversation that doesn't show great promise.

I feel slightly exasperated, but I can't blame them either. Depression, as they have known it, doesn't figure in the list of ailments vetoed by the society at large. They have never been at a social gathering where anyone ever spoke about mental health, though there have been particularly revealing conversations about problematic bowel movements, about the possibility of heart diseases, about skin diseases and even about watching too much television. Precautionary visits to general physicians and gynaeocologists are discussed and endorsed. But a psychiatrist? 'Mad' or what?

Christina, a blogger writing for UK-based Time to Change, summarises how a mental health issue is an 'alien' illness for large swathes of the world's population. "When you talk about being depressed, you often see people giving you this look, like they're not quite sure what to do or say and they might want to run away. You can see them scanning the horizon for all possible egress routes. You feel like maybe you should stop talking," she writes.

In India, visiting a trip to a psychiatrist is widely held against a help-seeker almost as an indictment of his 'mental problem'. And whatever problem you have, a 'mental' one is neither acceptable nor desirable. Depression, anxiety disorders and panic disorders have been repeatedly termed as commonplace and widely existent by mental health professionals. Yet, the stifling stigma around them, makes it impossible to even start a conversation around it, forget seeking treatment.

In personal spaces, families find it hard to dissociate themselves from the popular stigmas around mental health issue. In public spaces, governments have repeatedly dropped the ball on campaigns meant to dispel myths about mental health.

An example of how mental health issues like stress disorders are hush-hush in the country, is evident from the low reportage and studies on the mental health of the Indian Army. While there has been elaborate private and government projects to discuss and find solutions to Post Traumatic Stress Disorder (PTSD) faced by armies in the US and other countries, you may not have read much about the issues faced by the Indian Army.

A study, which suggests that there haven't been many 'reported' incidences of PTSD in the Indian Army, also observes that there is little credible research on the issue. The study titled "Stress in Indian Armed Forces: How True and What To Do?" points out:

"Indian studies in this field have been sporadic and scanty when compared to the large number of studies from Vietnam, Somalia, Kosovo and the ongoing operations in Iraq and Afghanistan, which are freely available in indexed psychiatric and combat journals or as service published monographs. Service psychiatry in the Indian Armed Forces is largely hospital based and this is reflected in the large number of studies on patient populations which cannot be generalised to the soldier in the field. Most combat psychiatric research work from the USA and Europe is done by psychiatrists posted in field units. It is perhaps time to experiment with a few field psychiatric units in the operational commands of the Indian Army. This experiment with field psychiatric units can be combined with centrally directed integrated research projects to improve yield in combat psychiatry."

The dismissive attitude to mental health in one of the country's most stressful occupations stands testimony to the general lack of concern and understanding of the subject. You can't help it then that in more personal spaces ruled by deeper anxieties, mental health is a no-go area during dinner table discussions. The irony here is that's where you should feel the safest and strongest to talk about it. What's stopping us really?

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