He is a young man in his mid 20’s whose name is Abram (name changed). He is an introvert and very shy, but he is a very hard working and honest man. He loved a girl but could not marry her because he was not in a so-called “reputed” job as per our society. He was carrying a lot of pressure in his head, he tried hard to remain happy, but he could not do so. He used to cry in silence in his room when no one was around. When I talked to him for the first time about his health, he said that he felt trapped in silence and humiliation. I told him, “You are ill, you are not your normal self, but I am with you and I will be with you in this journey”.
In medical terms, he was mentally ill, and he could not receive the emotional, moral and psychological support that he needed, which further aggravated his symptoms. His parents came to know when he cried over the phone talking to them, but they didn’t want to admit that it may be a case of mental illness. Instead of emotionally supporting him and taking him to a doctor they said, “There is nothing to worry, it happens to everyone. No one approaches a psychologist for a problem like this”! When he didn’t get the required support, he approached a psychologist, that too after a delay of one year. When his family and relatives came to know that he was taking professional help, they awarded him with abuses like- “You are mad, you are mental, you are weak, and you are responsible for all this.”
When you listen to this brief introduction about this man Abram, what do you make of him? Would you be hesitant, if this man comes to live next to you? Would you be happy working with him at your workplace? If this man had been your brother, would you have let others know that your brother is on medicines for a mental illness? Do you believe that he is responsible for his illness and it’s something he has caused within himself? Would you treat him differently, would you be a little more sympathetic to him or a little rude? Would you allow such a person to become a teacher to your children? Would you allow him to marry your sister if she wants to marry him?
The answers to all these questions lie on how we look at the cases of mental illness. All these questions are related to the mindset of the society and the taboo that surrounds mental illness. Sometimes it takes years for the patients to realise what is happening to them in the first place; because people around them and their family who always notice even a mild fever cannot notice a dangerous mental illness. Even if they do notice after a few years, the social precept of “Log kya kahenge, Samaaj kya sochega”, suppresses the most critical medical and psychological issues that need immediate attention!
In India, there is a tendency to make people believe they are “normal” even when they have been dealing with a critical issue that needs to be addressed urgently just to avoid judgement and gossip. Before we go into the details of mental health issues, let us first understand what sadness is and how it is different from mental illness. It’s normal to feel sad when you get some unintended result of your actions, have some unfulfilled expectations, face any kind of loss, feel stressed or get hurt when you believed that you were loved but you were wrong. If we look at the philosophical side of this: it is often said that to enjoy happiness you must also experience sadness otherwise it would have no value in your life. Most of the times feeling sad is a short-term problem but if you feel sad for an extended period, then you are probably facing mental illness.
What is mental illness?
Mental Health: According to an American Psychologist, mental illness is a disease that causes mild to severe disturbances in thought and/or behaviour. Like other medical illness, it is also a health problem related to changes in the brain. Like other illnesses, it also improves with appropriate treatment.
Why is talking about mental health issues a taboo? Why do we fear about “Log kya kahenge”?
People want to deny their problems related to mental health because they don’t have a clear understanding of what mental illness is and why it’s treatment should be a priority. They also deny this problem because they are concerned more about “Log kya kahenge” when people would come to know about their treatment, than being concerned about their health. People with mental illness fear change, that’s also a reason for denying and not acknowledging their problem. It’s unrealistic to expect cooperation from a society where people don’t have a clear understanding of mental health issues.
Generally, people cannot recognise mental illness at the first instance, even if they do, they don’t really know the way forward because there is so much of social stigma in the society that a person can never open up easily, in their early days when it’s easiest to treat any mental illness. A person suffering from a mental illness is scared to talk about it out of the fear of judgement and mockery by people, so along with helping the person in getting treatment, the society also needs to be empathetic.
Why is mental illness a social stigma in India?
1) There is a lack of awareness in our society because talking about mental illness has never been a part of our growing up and education; neither at homes nor schools.
2) In our movies, tv serials, novels and other books, patients of mental illness are depicted as someone who resorts to violence or is being treated at a mental hospital or is being held captive at some mental asylum.
3) Mental illnesses are not visible in most of the cases, even if it is noticed by someone; the society attaches various superstitious beliefs with the patient who is mentally ill.
Common myths related to the mental illness that exist in our society:
1) Mental illness is a sign of personal weakness and lack of willpower.
“Mard ko dard nahi hota, be a man, show your mental toughness…”. These are a few phrases which Abram always used to hear. Our society labels someone who goes through a mental health issue as weak. People who need clinical attention are not lazy or mentally weak, and they do not need to feel sorry for them when society forms an opinion about them. It’s just like any other disease caused due to an imbalance of the neurotransmitters in the brain which cannot be overcome only by willpower.
2) People with mental illness can never get back to their normal life. Due to the absence of positive thinking, hopelessness becomes a part of this illness, so people with mental illness may think that their life will never get better but in reality, positive thinking replaces all the hopelessness gradually when treatment is done and they get better.
How to break the social stigma?
1) Spread awareness:
It is a fact that we know little about mental illness and we don’t consider it important; because we are surrounded by myths and social stigma related to mental illness. We should be aware of mental health concerns and educate others as well by spreading the word starting from our family. We must emphasize that mental illness is not something to be ashamed of.
2) We should look for permanent solutions:
If a case of suicide of any famous personality comes on the news, we suddenly start talking about it. Discussions on media channels take place frequently, where we talk about social stigma, the taboo that surrounds mental illness but then after a few days, it all takes a back seat. We should frequently arrange seminars and discussions if we really want to change the social narrative of this social stigma.
Mental healthcare in India.
A survey conducted by NIMHANS, Bengaluru in 2016 says, roughly one in 20 Indians suffer from depression. According to WHO (World Health Organization), one in four people in the world gets affected due to mental disorders at some point in their lives. Currently, around 450 million people are suffering from such conditions which means it is also the leading cause of illness worldwide. In 2011, a study sponsored by WHO found out that 36% of Indians suffered from a major depressive episode at some point in their lifetime. This means that India is the leading country as far as the number of people who suffer from some form of mental illness at some point in their lives is concerned.
According to a report by WHO, less than 10% of those suffering from depression, get the access to the right medical treatment. In the US, this figure is 44%, and in South Korea, 82% get access to treatment. This shows the treatment gap of mental illness in our country which is due to a dearth of psychological experts and psychiatrist. In India, there are three psychiatrists for every one million people who are negligible as compared to the UK where there are over 14,000 psychiatrists for every one million.
When Abram was in the final year of his graduation, I motivated him to share his story with fellow students and teachers. When he shared, he got an unexpected positive response from his batch mates, juniors, seniors, and teachers. Many others also opened up that day to share their part of the struggles with mental illness.
There is a need for more discussions on this topic as this would create a friendly environment for those who are hesitant to talk about mental illness and fear of its social implications.