Healing Space | Let’s bring mental health home, India

We are a country where a five-year-old can learn to meditate from his grandfather. We can work with current beliefs and systems to devise a mental health care program that is our own, as opposed to a foreign implant. (Illustration by Suneesh K.)

Note to readers: Healing Space is a weekly series that helps you dive into your mental health and take charge of your wellbeing through practical DIY self-care methods.

In 2022, Indian mental health practitioners are still largely translating data, statistics and tests into Indian languages and the Indian context, be it the GAD-7 test for anxiety or the “religious or spiritual problem” category of the DSM-5.

We struggle with physical and emotional setbacks caused to schoolchildren whose parents will not get them vaccinated, or to patients who swear by unani, ayurveda and homeopathy but will not take an SSRI (selective serotonin reuptake inhibitors, used in mental health treatment).

We continue to struggle with the stigma of attending sessions, and imagine mental health to be something used by “crazy” people, who may have severe breakdowns, psychotic or neurotic episodes, and who cause harm to others i.e. “not people like me”.

Consequently, we miss the gradual build-up of tell-tale signs of depression, anxiety, but also of burn out, disorders from borderline personality or bipolarity, and early onset dementia that have documented treatment plans.

National Crime Report Bureau data, at its best inaccurate and underreported, points to the highest rate of suicides ever for 2021, an increase of 7.2 percent over the previous year. Many cases of death by suicide do not have a root cause in mental illness or depression, many are caused by localized issues such as domestic violence and debt, poverty and unemployment, and yet mental health interventions can alleviate some of the impact, if not all. People do not need to suffer with undiagnosed mental illness and yet, as a society, we stubbornly do.

It's time to bring psychological interventions stridently home. NIMHANS is one of the institutes constantly putting out research and developing indigenous psychological testing. Organisations like CMHLP (Centre for Mental Health Law & Policy), Pune, and Sangath, Bhopal, are creating a rich body of locally sourced research and community-based insight that give us a better understanding of who we are and how we think. The Mariwala Health Initiative’s Alliance for Suicide Prevention and the Queer Affirmative Counselling Practice is systematizing areas of lacuna.

Research shows that while we are behind in developing our own clinimetrics (as published in the ICJ), it is concertedly moving away from rigid medical models and entering into the space of understanding who we are as family units, societal units and individuals. But it’s still a drop in the ocean of awareness India needs to build across the diversity of our decentralized mental health landscape. Organisational effort is one part of it, the other is changing the language of mental health assimilation and with it, how we see ourselves.

Mental health adoption that comes to us from the west will always ever seem like a foreign intrusion. Universities and research centres in the west, from Columbia to NYU, are slowly adapting to the need for ‘cultural acclimatization’ of the therapist and realizing a bit late in the day that psychological research has historically marginalised the already marginalized communities, and been overwhelmingly western, white and first world.

The pandemic was an indicator that western systems, that we have historically looked towards, are overworked, stressed and inadequate at addressing not just immediate needs, but also work differently at assessing fall out on suicides to developmental milestones, simply because our society and family units are structured differently. Simply put, we need to start talking to each other a lot more, without waiting for the middleman of west-stamped research, with an aim to understand our own context.

The language of Indian mental health is being shaped far from the polished LED lights of the sanitized labs, in our schools, where counsellors have systematized access to children, in our rural centres and villages, where sporadic access to mental health services is based on the whim of an NGO or two, and in larger hospitals, places like Tata Memorial, where most patients encounter their first psychological testing as a mandate pre- and post-surgery. It is rustic and rudimentary and essential. If stigma will be vanquished, it will be in these mediums, not in dismissing those who have leaned on the local vaidya or baba, pulse reader and purohit and unani healer, but by listening to them and learning their fears and insecurities.

Habits are never entirely uprooted, they are replaced by other, stronger habits. So too with beliefs. A belief is never countered by fact, because a belief does not rely on data but on emotion. This is why we all know not to drink soda or eat highly processed foods but why we unrelentingly do, based on how it makes us feel.

Mental health especially in India gets pressed into service at a time of heightened feeling, during times of great grief or fear, anxiety or major life milestones. We have only just begun to create space for post-partum depression, staggeringly common, or why go so far, mood and affect disturbed by deficiencies in folic acid, iron and vitamins B and D3, high sugar levels, low protein, a lack of sunlight, social exposure, and exercise – basic contributors to personality and behaviour.

The reliance on what is trusted and known, social carriers of belief such as culture, ritual, indigenous medicine, community, spirituality, religion, is always higher than the johnny come lately of western science. Which is not to say we must throw one out in favour of the other, but that we have to learn to dovetail them so as not to alienate and disregard entrenched sentiment.

The battle for mental health is often played out as a battle against the prevalent, when we are better served working with the tide. That tide expresses itself in culture, song, dance, rhyme, rhythm, season, harvest, crop, food, drama, entertainment, popular culture, spirituality and self-esteem.

Extraordinary Attorney Woo, the Korean series, has done more for the understanding of the neurodivergence spectrum than any earnestly crafted pamphlet. Instead of constantly battling the disinformation spread by our television news anchors and Bollywood, we need mental health to become pervasive through our societal storytelling. For this we have to be willing to set aside the quantification-only models of flinging research at people, and engage on multiple levels, adopting some of their language, and encouraging them to take to ours.

We are a country in which a five-year-old can learn to meditate from a grandparent and thus arrive at a practice of self-reflection and emotional self-awareness. This is valuable and readily available methodology. The street play, or dance-drama, used often and with great effect in vast and varied social settings, attracts wide audiences willing to take home a moral. Television serials have wider audiences than theatre-goers. We could harness these already entrenched systems to great benefit. In this give and take, the exchange of ideas about mental health, using indigenous methods of self-contemplation and repurposing them in the service of self-betterment, we can arrive at a model all our own.

Mental health in India needs us to be part of a dialogue in which we are all speaking the same language. It may be emotional, sensitive, rational and irrational, part numerical and part dramatisation, but it will be our own vocabulary of the collective Indian mind.