Mental health is often considered the mainstay of the privileged. But, our sojourns into the hinterlands of Bundelkhand reveal that this discourse around mental well-being, as opposed to merely physical security, maybe reaching the grassroots. The resurgence of appropriate terminology to discuss mental health, for instance, maansik tanaav to replace ‘mental health,’ and anvaad to refer to ‘depression’ – suggests that while the elite English of mental health discourse may be foreign to rural India, the underlying conditions and symptoms it refers to are not.
People across the country are having to engage with the effects of a protracted lockdown and rising unemployment, compounded by the rampaging pandemic that shows no indication of slowing down. Further, the high-profile suicide of beloved Bollywood actor Sushant Singh Rajput has hit a note among the general public – bringing to the fore the urgency of discussing mental health in the contexts of both rural and urban India. A recent survey by the Indian Psychiatry Society (IPS) found that since the beginning of the lockdown, the number of mental illness cases had increased by 20% and that at least one in five Indians has been affected. The IPS also warned that the loss of livelihood and increasing levels of economic hardship, isolation, as well as the rise in domestic abuse engendered by the pandemic could trigger a new mental health crisis in India and “may substantially increase the risk of suicide”.
Our correspondents in Chitrakoot concur. Saloni Singh, who volunteers for coronavirus relief efforts, shares her experience, “Coronavirus is a terrifying illness, and it is even scarier because it is contagious. We are always worried that we are going to get it, especially since we are also doing relief work and delivering food to many people, among other things. And so there’s always the fear that we may catch it…even in my mohalla, two people got coronavirus since the lockdown started, and so everyone else is just trying to stay at home out of fear that they–or their family–will get it”.
While the fear of getting the virus and dealing with its accompanying medical, financial, and social burdens may be generating anxiety among countless Indians, Atul, the founder of Rukmini Seva Sansthan, another relief organisation, highlights how other mental health concerns are burgeoning in rural India due to the lockdown: “Since March 25, when the lockdown began, thousands of labourers have left their work in cities to head back to their villages. In this process, many have been left unemployed and penniless. Because of this, people have turned to crime. For instance, theft is prevalent in our town now.
There are many men who drink away their exhaustion and stress to finally end up beating their wives as a form of venting… Currently, the youth are predominantly affected by depression, because they do not have jobs but expenses are still rising, and their parents cannot support them. In such extreme pressures, they either commit suicide or suppress all their feelings to finally become chronically mentally ill. While typically people from the lower classes are more likely to commit suicide due to their circumstances, currently, the coronavirus pandemic has exacerbated situations such that even people from higher classes feel compelled towards depression and suicide”.
According to a 2018 World Health Organization report, 1 in 6 people in India suffer from mental illness, but over 80% of them are unable to access treatment. If, as Atul suggests, these disparities manifest across class, then it might also be worthwhile to consider the gendered distribution of mental health conditions. Studies have demonstrated that the pandemic and its resultant lockdown have disproportionately affected women, leading to increased stress caused by rising cases of domestic abuse, management of the household and finances and a huge spike in unpaid care work and emotional labour. The women we spoke to are certainly feeling the brunt of the lockdown, but continue to swallow their pride in order to keep the peace while bearing the weight of the world (and their demanding families) on their shoulders.
In 2017 alone, 197·3 million people had mental illness in India, including 45·7 million with depressive disorders and 44·9 million with anxiety disorders.
Mamta Vishvakarma, who works as a teacher, complains, “If women are angry, they do get upset and irritated and can tell their children or husband, but they can never actually do anything about it. Sometimes ironically they get further scolded for speaking up… women are often coerced into suppressing their feelings. I get very angry, and I directly approach the authorities. I don’t get any mental peace until I report things to the authorities. Otherwise, I get very irritable and can’t think of anything else and I angrily replay those thoughts for days. I can still vent by speaking up, but I have seen and spoken to many women who are unable to say anything and who remain mentally upset and frustrated, consequently ruining their health”.
Shehroz Fatima chimes in: “Women often end up channelling their frustrations towards themselves. They won’t eat, they won’t sleep, they’ll ruin their own health… some women may even hit their children. That becomes an outlet for their stress”.
Dr Narendra Dev Patel, a mental health expert in Chitrakoot helpfully highlights some symptoms and causes of mental health conditions, as experienced by some of his patients. “Some symptoms of depression include not being able to sleep, not feeling like speaking to anyone or like they want to kill themselves. At such a time if the person comes to the doctor, then they can be treated well. Yet, even today, society doesn’t consider this as a serious alternative. People prefer resorting to ‘jhaadh-phook’ superstition and rituals and going to babas or to spiritual retreats or places of worship. People go there and waste their time and further exacerbate the illness. If they just came to the specific doctors at the earliest, then they can be treated appropriately.
In today’s society – there is so much stress and competition. We can’t spend time with our family, because of excessive tension – we overexert ourselves, because of which we cannot sleep. Or we always have tension – that we have to beat someone else to get ahead, because of which we get depressed. In such a situation, there is a lack of the neurotransmitter serotonin because of which our will to work plummets. With medicine, we can increase serotonin levels, which can help reduce depression in the patient. There is also mania, or maansik unvaad in Hindi, where the patient speaks a lot, works beyond their capacity, spends a lot of money, can’t sleep, runs away from home. It’s the opposite of depression… again, we can use medicines to correct dopamine levels in patients with mania.”
Damayanti, a lawyer in the district explains the dual phenomena of the disproportionate impact of the lockdown on women’s mental health and general attitudes towards mental health in our country. For Damayanti, negative social conditioning has led to an internalization of harmful discourses around both gender and mental health. She says, “From the beginning itself, society and our environment encourages a different attitude towards women. Even if people insist that women are equal, invariably we see biases creeping through… Since their childhood, women are indoctrinated. They are told that they will grow up to go work at someone else’s house [once they are married] and are made to feel terrible if they don’t.
According to the WHO’s 2017 ‘Mental Health Atlas’ – mental health made up just 1.3% of the government’s total health expenditure.
When you’re younger you do not understand these things. But as women grow up, these thoughts take root in their mind and begin to affect their mental health. Secondly, the problem in our country is that people consider mental illness to be a form of madness. But it is not madness. People misunderstand mental illness and hesitate to even go to doctors with their conditions to get treated. They think that people will judge them for being “mad,” which is why they shy away from doctors.
In our families, we tend to ignore small mental stressors, assuming that only if it escalates into madness it is a matter of mental illness. That is not the case. Mental illness can be identified through mundane indicators: getting angry at little things, being stubborn and throwing tantrums. In the case of women, they get scared of talking to people – even that is a form of mental stress… women get scared of going outside, going alone, they get upset at little things, begin to feel scared and anxious about what is going to happen. All of this is a mental illness and we are responsible for this. We don’t pay attention to it, treat it, or even go to the doctor. The discourse around mental health in our country is misguided, we assume that being mentally ill amounts to being mad. This attitude needs to change”.
It may serve us well to heed Damayanti’s warnings. In 2017 alone, 197·3 million people had mental illness in India, including 45·7 million with depressive disorders and 44·9 million with anxiety disorders. Since 1990, the proportional contribution of mental disorders to the total disease burden in India has almost doubled. In fact, recent government efforts such as the Mental Health Act of 2017 and the provision for mental health facilities for healthcare workers on the frontlines battling the COVID 19 pandemic suggest that mental health is slowly emerging as a priority in contemporary India.
These baby steps arrive on the heels of many emerging and alarming statistics – such as a 2017 survey by the World Health Organization which found that India had the highest number of people with depression in the world, and the second-highest number of people with anxiety, after China. According to the WHO’s 2017 ‘Mental Health Atlas’ – mental health made up just 1.3% of the government’s total health expenditure, which itself is a fraction of the total healthcare budget which stands at a mere 1.28% of India’s GDP.
Dr Patel further clarifies as to the spike in the mental health crisis in 2020, “Right now, depression is the most prominent mental illness. Because of the pandemic, everyone is losing their jobs, they are staying at home, they have a lot of mental stress. For instance, people’s businesses are shutting down, they can’t go to work, they are worried about the future of their family. It was like this earlier too, but the pandemic has further worsened these conditions.” He ends with a plea: “If someone you know is depressed please approach your closest mental health doctor who can treat them through appropriate medical treatment and can observe the patient”.
India’s battle against mental illness and the stigma associated with it will be just as long drawn out and challenging and will require perhaps just as much empathy and access to resources, like that against COVID-19.
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