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Medication And Counselling Might Not Be The Ultimate Answer To Mental Health. Here’s Why

More from Tanushree Ghosh

Trigger warning: Suicide, acute mental conditions

The pandemic has brought the concern of mental health and its severe manifestations (suicide, domestic violence) to the forefront. It’s about time, so this is one good thing out of the otherwise impending doom. However, there are several points that are persistently misunderstood or remain lesser-known, no matter how much dialogue happens.

I have lost the closest person I have ever had, and quite a few others, to suicide. I have struggled with (and often struggle with) both forgiveness and anger. I have felt guilt for my own thoughts (the potential ‘selfishness’ of it all, especially since I have a young daughter). Yet, I also want acceptance and understanding when someone chooses to end their life.

I have familiarity with extensive counselling and medication-based treatment plans. I have closely witnessed this as a partner, and because of my constant writing and speaking out on mental health, I have had several (mostly women, but also men) share their struggles with me. I have learned from their journey and, in some cases, have had a very close view of their treatment (success and challenges). I am stating these here because if needed, I am happy to share the details of treatment plans and journeys to help disperse doubts, stigma and misconceptions around this topic.

Is Mental Health Clinical Or Situational?

This point can be stated with a single sentence, but needs to be explained, for this is a key contributor to the misunderstandings around mental health. Situational mental health conditions — sadness, depression, or an abrupt phase of anxiety) caused by a life event needs to be considered separately from clinical conditions.

When Sadhguru advises us on controlling our minds or looking into our past and finding examples of how we were able to overcome situations, we are quite possibly talking about non-clinical conditions. To confound this, it is not that clinical conditions can’t benefit from mind modulation. Counselling and redressal techniques — from cognitive and EMDR therapies, to well-known findings on meditation and the comparatively recent findings of neuro-plasticity — all support this.

However, mental health is a spectrum. So this doesn’t imply all clinical conditions can be remedied or ‘cured’ by mind management (or, as more often put, through ‘self-belief and confidence’). Clinical conditions have a plethora of causes — from neurological to hormonal — and there are examples of situational developments triggering clinical onsets.

Long story short: mental science is complex and nascent. We need to learn the facts (whether it affects us or not), especially today, when we can find veritable, scientific information online before placing universal expectations of ‘think positive and push through’.

Let’s take a parallel: some patients do extremely well in cancer, with a healthy lifestyle, positive thinking and routine chemo. They have no remission. But there are patients who, despite the best of efforts, have their cancer metastasize. My uncle survived two years on stage four lung cancer, but I don’t get surprised when I hear of my friend’s father getting detected at the same stage, yet passing away in two months.

None of these comparisons will fit apples to apples of course, but they fit close enough to help guide our thought process towards framing mental ailments (especially ones that can have high functioning manifestations and situational variants) as conditions, not choices.

The Unknown Middle

There is a huge ‘unknown’ middle/overlap when it comes to mental ailments. I know of at least two individuals who had situational conditions morph into serious clinical manifestations, including psychosis. And of course, I know of numerous for whom situational conditions got better and are now more like seasonal ailments, which they have learned to manage with time.

In my personal experience, I have learned and accumulated ‘tools’ over the years to be able to manage a clinical condition to the extent that it’s immaterial. It hasn’t gone away — I am not ‘cured’ — but it’s managed (Most of these conditions, like diabetes, can be managed, not cured). Also, most mental health medications are still by trial (I have psychiatrists and several online mental health forums I can direct folks to who might challenge this).

Mental health is a spectrum. This doesn’t imply all clinical conditions can be remedied or ‘cured’ by mind management (i.e. ‘self-belief and confidence’).

Just because I go see a doctor and get prescribed SSRIs (Seratonin Inhibitors), for example, doesn’t mean that

a) the known functional dose (which, for most drugs, is a range) will work for me as well as it did for person X.

b) or the drug will have side effects that are mirrored to someone else’s.

I was, for example, put on a particular medication that I should have done well with, given my history. But instead, I got extremely suicidal. One important point to note here is that getting suicidal (or having suicidal thoughts) has stages or degrees of intensity. There can be long-lasting periods of such deep urge that it’s akin to compulsion.

At such times, the option of ‘stopping and thinking of calling a friend or helpline’ doesn’t exist. This can be neurological, hormonal, or otherwise physiologically-manifested as a part of the disease, or brought about as a side-effect of your medication. And again, clinical conditions, most often than not, will worsen with life events (situations). The phases can also worsen with progressive years, or get better.

Let me offer some parallels. I have been an incredibly cheerful, not-a-care-in-the-world-class topper who has, in much easier years of her life, struggled severely with a clinical condition (Meaning, the same person can be different at different times, for reasons unknown). I have migraines, which I know how to manage. But ever since moving to an arid climate, I get severe sinusitis, which triggers a migraine. And then, in a terrible catch-22, the migraine triggers the sinusitis back.

I don’t know how to manage my migraine anymore, and have days when I can’t get up from the bed. All the medications that worked for migraine, don’t work anymore, because of the combined worsened condition. Also, I have many friends who have migraine, sinus or both. I see them faring much better, reacting much better to medication, and in general, being better with pain management (Meaning, the same condition, can worsen or have a different impact when compounded with a new modulator, and can be different for different people). 

On the days I don’t have migraines, I laugh, work and party hard (Meaning, there can be better and worse days for every ailment). I am not trying to make things simplistic. I am trying to point out how ridiculously simplistic the common and immediate reactions we have on mental health are: how were they so much stronger in their youth? How can they have smiling pictures just a week back?

Mental health experience, and how one functions with it, varies. Just because ‘I’ am ‘strong’, doesn’t mean everyone is. Just because I know person Y can cook all day with a migraine, I don’t feel bad (or am not made to feel bad) if I can’t. Because it might be that I am indeed less tolerant to pain (which is something I doubt very few people will fault anyone else for, unless the pain is a beyond any doubt a band-aid boo-boo situation). But it might also be because my condition is indeed more severe, and/or my physiological reaction to it is different.

Most mental health medications are still by trial. Just because I go see a doctor and get prescribed SSRIs, for example, doesn’t mean that the known functional dose will work for me as well as it did for person X, or the drug will have side effects that are mirrored to someone else’s.

Someone’s reaction to severe devastation might be much calmer than my reaction to the loss of my house. That might be because of my underlying clinical condition, a completely new condition triggered inexplicably by this loss, or because I have less mental strength, or thought management power, or value and support system to pull me through.

This is where I feel the life-coaching business need to be extra sensitive. No one is challenging that there is value there. But acknowledging medical science and being cognisant of the unknown is a critical responsibility, before promises are made on ‘manifestation out of depression’ and ‘removing anxiety through power exercises’.

And just because I am battling, doesn’t mean ‘I’ am broken. Battling clinical conditions doesn’t make them non-functional or dysfunctional. They can mostly, and at most times, be high functioning. This seems to surprise us, and is actually a catch-22. Because of this extrapolated assumption, most of us will not be able to make their conditions public. Just like we won’t doubt if we hear an ever-smiling someone we know died of severe colon infection, which they chose to fight a silent battle with, instead of going public, we shouldn’t assume people owe us a real-time update on their mental health or demand constant proof to be able to believe.

Talking To Someone Is Not Easy

Continuing on the point above, the reason most folks, including myself, will not be sharing our underlying condition or inner thoughts every time we smile and have a good time with you is that there’s a high chance you will not understand or not know what to do with the information. We don’t blame you for that. But we don’t want to discomfort you.

There’s a high chance you will not be able to get what was shared, and will talk about it behind our backs. And you will not talk about me having depression the same way you would ask me about having diabetes. Again, we don’t judge you for this, but this is why we will feel further inhibited in sharing our mental plight with you.

There’s a high chance that you will not get the magnitude and intensity. For example, you might understand when I am feeling sad and, with the best of your intentions, provide some guiding thoughts. But you won’t understand why I can’t stop thinking about the ceiling fan (obsessive thinking merging into depression) when everything in my life is well.

As you share this, there might be implications on your job, the opportunities you get, and even relations you can have in life. This point doesn’t require elaboration. The only way around it is by demonstrating again and again that just because there’s a mental condition, doesn’t mean there will be an extrapolation into dysfunctional.

“Everyone going through a severe situation should reach out” is a piece of advice we shell out, but we need to understand that that option doesn’t exist for most.

So, in sum, talking to friends or close relations won’t work, because they won’t understand, will be unnecessarily worried, and would make it worse. Even with the best of intentions, most of us will fail. I have had several trained coaches give up, overwhelmed and helpless. Talking to a therapist or counsellor is also easier said than done, and I will possibly write a follow-up piece outlining 15 years of personal and close contact experience in multiple countries to outline why.

But for now, I will just leave it by noting the key problems: finding a good fit, finding an effective fit, and finding someone who will have availability (geo-based challenges differ and include further considerations around expense, insurance specialisation, etc.). “Everyone going through a severe situation should reach out” is a piece of advice we shell out, but we need to understand that that option doesn’t exist for most. A  friend whose daughter shot herself in her head said this best: she was so surrounded, yet so alone.

The acceptance of suicide doesn’t mean encouraging or role-modelling suicide.

The most difficult point to make on suicide is putting on a garb of acceptance, in place of looking at it as a selfish and cowardly act. We have perpetuated this by making attempted suicide a criminal offense (in several nations), and by touting the idea of suicide being a sin. All that would be valid if it was a black and white matter of an individual (with responsibilities and loved ones presumably) really ‘choosing’ to take this path of ultimate abandonment.

However, as we hopefully have established, the act, albeit self-initiated, is a side-effect of an ailment causing the loss of life. I have been in a place where I have harbored tremendous resentment towards someone for ‘choosing’ such an act. But I am writing this piece today so that such thoughts stop one day; so that everyone who falls off the cliff, losing the battle (and trust me, they have fought tooth and nail) are understood by their loved ones; so that their end is accepted with no resentment towards them, just like we would accept the death of a loved one from a fatal accident or a terminal physical ailment.

About the author: You can reach out to the author at @thoughtsnrights or www.thoughtsandrights.com. Other available works can be found at: From An-Other Land

Note: The article was originally published here

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Now as an MH Fellow with YKA, she’s expanding her impressive scope of work further by launching a campaign to facilitate the process of ensuring better menstrual health and SRH services for women residing in correctional homes in West Bengal. The campaign will entail an independent study to take stalk of the present conditions of MHM in correctional homes across the state and use its findings to build public support and political will to take the necessary action.

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Harshita is a psychologist and works to support people with mental health issues, particularly adolescents who are survivors of violence. Associated with the Azadi Foundation in UP, Harshita became an MHM Fellow with YKA, with the aim of promoting better menstrual health.

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A student from Delhi School of Social work, Vineet is a part of Project Sakhi Saheli, an initiative by the students of Delhi school of Social Work to create awareness on Menstrual Health and combat Period Poverty. Along with MHM Action Fellow Sabna, Vineet launched Menstratalk, a campaign that aims to put an end to period poverty and smash menstrual taboos in society.

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A former Assistant Secretary with the Ministry of Women and Child Development in West Bengal for three months, Lakshmi Bhavya has been championing the cause of menstrual hygiene in her district. By associating herself with the Lalana Campaign, a holistic menstrual hygiene awareness campaign which is conducted by the Anahat NGO, Lakshmi has been slowly breaking taboos when it comes to periods and menstrual hygiene.

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