In India, since times immemorial, we have always believed in the principle of holistic well-being – physical, mental and even spiritual. Among our civilisational claims to fame in the times of yore are the ancient medical science known as Ayurveda (that arises from the Sanskrit words Ayur or life, and Veda or science) as well as the addressing of mental health. In the Rig Veda, topics such as the exploration of methods for attaining mental happiness, prayers for mental happiness and methods of increasing medha (intelligence) have been looked at. In first six mantras of Shiv Sankalpamastu, important characteristics of Manas has been described, where subjects such as the speed of mind and the state of mind during different states of wakefulness and consciousness are spoken about.
The mind has been described as the instrument of knowledge and basis of consciousness in these ancient texts. Classification of mental disabilities based on endogenous and exogenous factors has been done systematically in Ayurvedic texts such as the Sushruta Samhita and Charak Samhita: we have Nijmanasrog (endogenous mental disabilities), which is further divided into Manas Dosh Janya caused by psychological factors and Sharir Doshanubandh Janya caused by physical illnesses, and Agantujmanasrog (exogeneous mental disabilities). Even with such extensive knowledge and understanding of this side of human existence, the tragedy is the way many Indians treat mental health, mental disabilities and disorders today.
Within the health related Sustainable Development Goals (SDGs), one target that is directly associated with mental health is Target 3.4:
By 2030, reduce by one third premature mortality from non-communicable diseases through prevention and treatment and promote mental health and well-being.
As per a report by the WHO 7.5% of the Indian population suffers from some form of mental disability or disorder, and India accounts for nearly 15% of the global mental, neurological and substance abuse cases. WHO predicted that by 2020, roughly 20% of Indians shall suffer from mental illnesses, and to make matters worrisome, we have no more than around 4,000 mental health professionals to tackle this challenge! The National Mental Health Survey of India 2015-2016, supported by Ministry of Health and Family Welfare (Government of India) and implemented by the National Institute of Mental Health and Neuro Sciences (NIMHANS) – Bengaluru, had some eye-opening findings in this regard. The National Mental Health Survey quantified the burden of those suffering from mental, neurological and substance abuse problems and found that while nearly 150 million Indians needed mental health care services, less than 20% were actively seeking support and care! Some startling findings included: 1 in 20 people in India suffered from depression, there is high prevalence of psychoactive substance abuse, high suicidal risk for nearly 1% of the population and people in the ‘productive age group (30-49 years)’ (terminology from the Survey Report) were affected the most. It was also seen that
Mental disabilities and disorder affect everyone, regardless of gender, age, lifestyle or residence, even though some groups are at higher risk for certain illnesses
In India, even today and among the youth too, if someone says they are undergoing treatment or support for any mental health issue, you can get a range of reactions from some people: from judgemental astonisment to outright humiliation with derogatory comments such as ‘pagalpan‘ – madness and even ‘defect’, as crass and inhuman as that is! Even today, we have people who take it as an insult if someone is asked to seek help or support for a point of concern when it comes to mental health. Even today, we have people who find it much better to outcast and throw out people from their circles and lives for mental health issues than engage with them with understanding, love, trust and respect. People will speak about you behind your back, insult and mock, gossip and deride any such individual rather than having the least bit of true understanding and concern.
People with mental health disabilities do not need anyone’s pity or mercy, they need understanding.
For anyone to discuss their mental health can be scary, especially in a society that stigmatises mental illnesses. However, it is of utmost importance to do so, so that the people who care for you are able to support and help you. It also liberates you from either living with the fear of someone finding out about your struggle or adversely affecting anyone without their full knowledge of your condition.
Stigma and discrimination are consequences of misinformation and ignorance. Some studies on mental health literacy, particularly one titled ‘Mental Health Literacy Among Late Adolescents in South India: What They Know and What Attitudes Drive Them‘ published in the Indian Journal of Psychological Medicine in 2016, show a grim reality: mental health literacy among adolescents is extremely low with depression being identified by around 29% and schizophrenia/psychosis being recognized only by around 1.3%. Invariably stigma was seen to influence (worryingly) help-seeking.
As per the work titled ‘The burden of mental disorders across the states of India: the Global Burden of Disease Study 1990–2017‘ published in The Lancet Psychiatry in February 2020, more than 197 million people had mental disorders in India in 2017. In 2017, depressive disorders were seen to contribute the most to the total mental disorders Disability-Adjusted Life Year (DALY). For my readers who are not familiar with DALY, a Disability-Adjusted Life Year is a measure of overall burden of a disease or disorder, expressed as the number of years lost due to disability, ill-health or early death. Depressive disorders contribute around 33% to DALYs in 2017, followed by anxiety disorders at 19%, idiopathic developmental intellectual disability or IDID at around 11%, schizophrenia at around 10%, bipolar disorder at around 7%, conduct disorder at around 6%, autism spectrum disorders at around 3%, eating disorders at around 2% and Attention-Deficit Hyperactivity Disorder (ADHD) at 0·3%.
As you can see, the range of disabilities and disorders is large, as is the seriousness and nature of each as and when manifested in different individuals. There is no one category or classification or broad wording that can be or must be presented for individuals with mental health disability. Some disorders are from birth while some emerge over time. Some are curable and temporary while others are more sustained and possibly life-long. As you can see, governments across the world have taken significant steps to help bridge the gap between people with these disabilities and those without:
percentages (Source: WHO Mental Health Atlas Report 2017)
However, as mentioned previously the biggest hurdle seen in India, as around the world, is
Breaking the barrier
Every individual must learn to discuss mental health, disability or disorder and speak up on the same, with ease and understanding, and not as a point of discomfort, shame or stigma, as is seen by multiple studies and groups studying mental health in India over the years. Whether you tell one person, talk to a doctor or a health professional or become an advocate for mental health awareness, it is extremely important to share your story to help yourself and others. I have known instances, very closely, where someone not doing so has ended up affecting the professional lives (with attention deficit syndrome coming into play without active acknowledgement, in one case), relationships (with somebody, in another case, even being rejected for a mental health condition instead of being spoken to caringly!) and general welfare of individuals, especially when the other side that learned about their disability or disorder was insensitive or misinformed about mental health! And it can be devastating. There is no greater pain a person can have than be judged and spoken about in harsh terms, due to something not in one’s control. The only way out is trying to reach out, engage, share and seek support wherever one can. If the other side has the capacity and sensitivity to understand, well and good; if not, well, don’t bother!
In a society with stigma around mental health, do not beg or plead anyone to understand your condition or disability, if any. Mental health disabilities and disorders need not be convoluted with any loss of dignity and self-respect!
What’s most important is to think about who you want to share and how much information you want to share. Not everyone will care or have the understanding or sensitivity to hear you out or understand you. Some may even mock you or gossip about you. If you feel vulnerable and unable to cross this initial boundary, it makes sense to talk to your closest friends first. Just try to prioritize those you can be frank and open to, and who shall be supportive and understanding. There are some ways to make sure that your point reaches across to the person you are communicating to: prime the conversation (start by letting the person know what you are about to say is serious and important to you), write it out if that helps (so that you can gather your thoughts and place them in one place before sharing), use examples (this is useful to communicate disabilities and disorders especially to those who have never experienced and cannot go all the way in realising the seriousness and nature of the condition), let them know how they can help and ask the person to help you talk to others. These are various nuances and points that are hardly discussed or known in India today!
On the other side, if someone opens up to you about their mental health, disability or disorder, the first and most important thing you can do is: listen. Simply listen. Do not make assumptions and definitely do not jump to conclusions. Make them feel comfortable and secure, and listen to them thoughtfully and carefully. The second most important thing is to believe them. It is easy to just shrug it off as somebody making something up or joking but when somebody with a genuine issue faces this, it is devastating for them. It makes them feel alone and afraid, especially if they needed to muster a lot of courage to tell you! If they feel judged or dismissed, it might discourage them to talk to you or anyone else about their problems in the future. Do not treat them differently, like a ‘mental case’ as some very insensitively and inhumanly put it. Ostracisation or discrimination is the worst punishment a person with a mental disability or disorder can be given, for no fault of theirs. Do not gossip mindlessly about their condition (since the person opening up is sharing private medical information and this must not be shared lightly) and instead ask how you can help. Gently ask them to seek support from professionals if need be and accompany them, if you can. Not once with the feeling of charity or pity but understanding. Not once with misinformation or insensitivity. For the worst thing you can do to someone is misuse this condition or information about it, in society. As they say, scars on your body can heal with time but scars like this, almost like on the soul (subject to your belief in souls; heart would do otherwise), never go.
During this period of crisis and uncertainty, as we battle Coronavirus the world over, it is important to look after your mental health. I have always spoken for spiritualisation and calming the mind. However, I feel some of the following points and steps can also be quite helpful:
I write here with experiences and thoughts that I have collected over the years, particularly while working on mental health in my Stephanian days and in the University of Cambridge as a student leader and activist.
I will end by saying that many of us may have watched the famous movie A Beautiful Mind. For me,
All minds are beautiful. They are just sometimes beautiful in different ways!
Speak up, on mental health. Stigmatise not!
