By Swarnima Bhattacharya
It might be a slightly misleading exercise to undertake a qualitative analysis of the state of mental and psychological healthcare in the country, seeing as it is practically non-existent. Despite India’s first ever national mental health policy having been launched in 2014, there seems to be absolutely no concrete, organically evolving discourse on the ground to further the good intentions of the policy.
Adding to the existing stigma and silences around mental issues, are the very problematic, and often insensitive, myths propagated by popular culture about such afflictions. Remember watching Parineeti Chopra as “mental Meeta” in the film Hasee toh Phasee, and the highly romanticised, and ridiculous, portrayal of acute depression and suicidal tendencies in Priyanka Chopra-starrer Anjana Anjani? Well, these are to name just a handful.
Battling such unhealthy perceptions about mental illness —which is NOT synonymous with “madness”— is a novel initiative, The Shrinking Couch. Co-founded by Nivida Chandra and Krutika Bopanna, this is an online platform that enables discussions and disseminates information on mental health, care-giving and treatment. As part of our discussions during the World Mental Health Week, NewsGram caught up with Nivida Chandra, for a conversation on all things “mental”.
Excerpts from the conversation-
What prompted you to kick start an initiative like The Shrinking Couch? What lacunae did you find in the mental health care sector that you sought to fill in with this online platform?
–The Shrinking Couch tries to deal with several challenges facing the mental health care sector but does it at an individual level. Krutika and I often discussed the state of affairs, and saw trouble everywhere. For one, the ratio of caregivers to the number of people who needed help is very skewed. Further we had no way to recognise a good and certified therapist from someone who wasn’t one. So between the quantity and quality of help available, the stigma surrounding mental illness and a healthy awareness and acceptance of these issues- we found TSC to be the ideal solution.
We started TSC as a forum where people could both share their stories, and a platform from where those reading could feel connected and learn something – whether for themselves, or for someone they loved. For instance, if someone has been feeling depressed, but doesn’t have help close at hand or the option of getting help or the knowledge that help is available, s/he can read the innumerable experiences shared by many of our contributors, and see that s/he isn’t alone. Experiences of others also often give us insights for dealing with our personal issues, especially when we find our own stories mirrored in those of others. In this way, we see a symbolic “shrinking” of the proverbial “Freudian Couch”. Hence the name, The Shrinking Couch, which seeks to be an additive layer upon the traditional methods of therapy and care-giving especially since it takes into account the quality of care, anonymity of expression and knowledge about the conditions.
About the quality of care, we have noticed how one-on-one therapy is almost invariably too heavy on the pocket. And “taking therapy”, as an idea, is extremely urban. Do you feel that seeking help for mental afflictions has become a luxury for the rich?
–Yes, to some extent, I can’t deny that. Again, however, the ratio is very skewed. There are way too many people who need help, and an even greater number of people who don’t even know yet that they could do with some help. Very few people are certified practitioners giving therapy.
I find the rural – urban divide too redundant. There are two barriers to entry: money and mindset.
Those with money who want help, may still find NGOs giving the service free of charge, and those with the right mindset might save up a paltry sum to seek out whatever they can afford. There is a lot of good work going on in rural India to try and deliver evidence-based therapies to those who need them, and research is showing that it is being well received. There is actually no such well-intentioned outreach in our so-called urban spaces. So I find the rural-urban split unhelpful when thinking of therapy.
In the West, for instance, corporate places and institutes encourage employees to take up therapy; some often even bear costs for this. There is no such culture in India, though I’m not sure if this is how I would want us to move towards a culture of acceptance either. You don’t get help because someone is giving it to you for free. You have to learn to recognize when you need help for your mind and go get it proactively.
Moreover, concepts such as group therapy, which are much more practical, are almost alien ideas, known by only a few. I recently received a long phone call from a girl in “urban” Rajasthan, educated and financially well-off, but up against extremely regressive parents. She went ahead and sought help for depression and found that her therapist was playing ‘tetris’, hiding her phone under her table. Frankly I don’t care if that person was delivering this for free (they weren’t); this is unacceptable. It speaks volumes about the lack of ethics, the sensitivity and the importance that is placed on mental health.
Can you talk a little more about the stigma that is ruthlessly attached to mental issues? Why this social, cultural, communal fear in confronting these issues as they are?
–This is actually really easy to understand. The most important reason for this is that a mental issue, say depression or alcoholism, doesn’t really exist in a vacuum. It is not an individual affliction.
In the case of mental and psychological afflictions, the familial and psychical environment, and the social context of the individual play a major role.
It could be the oppressive family, a hostile workplace, the adulterous/uncaring spouse, the unsupportive parents-in-law, the abusive teacher or the bullying classmate. It can be one, or all of these that come together to form an environment of ill-health. It is because the people around you are easily implicated, that a culture of silence is inculcated. This works in two ways: one, you don’t always feel confident about blaming those you love for your miseries, and two, most of the time, none of those around you want to take responsibility, or help you. So you end up feeling blamed and cornered, and ultimately alone, and likely mad.
It is rather paradoxical that your surrounding environment contributes to your mental affliction, but at the same time you are singled out for the blame. A common response to conditions such as depression and anxiety is that the person isn’t strong enough, or s/he should “calm down” or “move on”. What would you say about that?
–Yes, the culture of blame only worsens the already existing culture of silence. Most of the time, the sufferers also dismiss some very real issues as nothing more than “bouts of sadness” or a “rough patch”, because they themselves are resistant to the idea of being “mentally ill.” The general perception about mental healthcare facilities is far from encouraging. Psychiatric facilities are dingy colonial cob webbed buildings and boldly called paagal khanas – and I’m talking about ‘developed’ cities. In electroconvulsive therapy, medication and institutionalization can be forced upon you without any need to prove their requirement. So most people, very conveniently, are quick to associate mental and psychological afflictions with personal failing.
Internalising blame and victim-shaming are the major challenges facing mental healthcare in India.
When someone is told to move on, their feelings are not validated. They are made to feel false and silly, or perhaps dramatic and crying for attention. This actually pushes the person to either shut up, bottle it in, or break down and literally give in to being ‘mad’. Unfortunately, this fear of no one understanding them is what leads men to drink, women to cheat, and people to scream, hit and actually lose their human sense.
At TSC, we receive innumerable long, detailed letters and messages on Facebook by people asking if they can share their stories anonymously, or if they can even write at all. There is not only the fear of confronting the society but also yourself. Many women, for instance, just deal with their husbands “hitting” them. But once you get down to writing, the process of contemplation and transcription doesn’t allow you to view it as just “hitting”. Then, you realise you are in an abusive relationship. It is not easy to confront such revelations even at a very personal level, and obviously the social, cultural, legal and medical infrastructure does not make it easy.
The problems are truly wide-ranging. So, right from the resistance one faces internally and from the family, there are also challenges at the policy level. There has been sporadic talk about decriminalizing suicide, but none of that is actually in the offing. What would you say about that?
–A person who is brought to the brink of killing himself, and tries to do so, was legally viewed as a criminal until last year. Obviously it is all kinds of screwed up! I had written about suicide and the logic of preventing it a while ago. It took years of policy debate and much labor by the new mental health proposal to the government to convince them that a sad, struggling person is not a criminal, but needs help. A person who tries to commit suicide is NOT a weakling, and is not a hindrance to the precious right to live. So, yes, the policies are totally misplaced. There are still others on the right to vote, on holding property, and basic provision of care. A great proposal made was that of Advance Directive, in which a person has the right to decide his course of treatment should he or she have to be taken into a psychiatric facility and so on. It’s a beautiful detailed proposal that is yet to be passed. I’m sure there are other such proposals as well.
Is there anything else you would like to say to our readers about the work you do at The Shrinking Couch?
–I would welcome experiences and stories from as many people as would like to write. Everyone is welcome to share. For starters, you are welcome to read the stories that have very bravely been shared by many of our readers. This exercise of writing and reading is more therapeutic than most people realize. In the World Mental Health Week, I would encourage people to reflect, share, reach out and help, and also get help.