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The Silent Relationship | An Overview of the 'Mental Health' month

The label of “paagal” is popular in our culture, and we usually use it in the context of humor. But it is precisely the fear of this label (even in a joking way) that deters people from seeing a mental health professional on a consistent basis.

According to WHO, nearly 56 million Indians, that is 4.5% of India’s population, suffer from depression. 38 million Indians, that is 3% of the population suffer from anxiety disorders including panic attacks, post-traumatic stress disorder, and other personality disorders. Nobody wants to talk about the state of mental health in our country which is of great concern. There are only about 43 mental hospitals in our country of 132 crore people and most of them lack essential infrastructure and treatment facilities.

In this expeditiously moving life, we forget to look at people around us. We have been having a constant mental health crisis in our country especially with the continuous ongoing stigma associated with it. Most of us are so busy with the race of life that we forget that each person runs at their own pace. Imagine running a race where you are an athlete and the other person doesn’t have a leg. Is the race fair? Winning this race has become so important that people don’t look around, stop and help the unprivileged.

According to WHO, nearly 56 million Indians, that is 4.5% of India’s population, suffer from depression. 38 million Indians, that is 3% of the population suffer from anxiety disorders including panic attacks, post-traumatic stress disorder, and other personality disorders. Nobody wants to talk about the state of mental health in our country which is of great concern. There are only about 43 mental hospitals in our country of 132 crore people and most of them lack essential infrastructure and treatment facilities. The private mental health facilities charge more money than the government hospitals which is unaffordable for most people. It is terrifying that if a person is diagnosed with a mental illness, they might lose their job, friends, family and may or may not receive unaffordable health care, but if a person is diagnosed with a physical illness, they would be surrounded by love, care, and positivity. In India, if a person talks about their mental health apart from the stress that is penetrating in them, they are called ‘crazy’ or a lunatic. Visiting a psychiatrist is considered disgraceful and shameful in our society.

Mental illnesses are used as an adjective and insult. Sadness is mistaken for depression, nervousness for anxiety, zoning out for dissociation, mood swings for bipolarity, the word ‘retarded’ is thrown around so casually as an insult. It is so much more than that. Mental illness is not something you can pretend to have. It is not a trend to be a part of. It is not seeking attention. Mental health is real health and should be treated and cared for just like physical health.

Mental health disorders are not a result of personal weaknesses or character flaws. Though the exact cause of most mental illnesses is not known, some of them are caused by abnormal functioning of nerve cells. Nerve cells in the brain communicate through neurotransmitters. Like a fast-moving relay race, neurotransmitters are the vehicle by which messages travel from one nerve cell to another in the brain. They affect mood, memory and our ability to concentrate, as well as several physical processes. When these chemical messengers are disrupted, the message may go right back to the transmitter or be lost altogether. When considering mental illness, the result of interrupted neurotransmitters can be depression, and their malfunction causes anxiety. Additional mental illnesses, such as personality disorders and social disorders, are believed to be caused by the hindered transfer of neurotransmitter messages. Some mental illnesses are caused by childhood trauma, abuse, and upbringing. Speaking up about this silent relationship a person has with mental health can be very challenging and difficult especially due to the negative response inclined to it.

While the planning of our towns and cities cannot be blamed for causing all these issues, it does have the ability to intervene, and thus, a role to play in improving urban life. With increasing urbanization, the impacts on the natural quality of life have changed due to the environmental, social and psychological changes associated with it. As a consequence of increased noise and light pollutants, toxic asphalt roads, pollution, lack of green cover and walkable spaces in our public realms, urban life is not always relaxing.

Because of the non-walkable, non-inclusive, depraved and polluted nature of our contemporary mega-cities, people have increasingly started spending their leisure time indoors, where often the indoor air quality is 15 times more polluted than the outside. Our developed counterparts have proven to be successful in making their cities more livable, through providing equitable public realms that have no dearth of vibrancy, respite, and leisure. Their public spaces offer sustainable mobility, mixed cultural ethos, and a variety of public activities; which eventually end up facilitating more social interactions and a greater sense of belonging among the citizens. This, in turn, makes their cities more lively, affordable, clean and engaging. On the other hand, our overburdened cities provide little public space that can be termed therapeutic in any sense. The poorly designed spaces in our cities generally inhibit walking and other physical activities, promote inactive lifestyles; and are detrimental to social interactions.

Our roads are broken and choked, and the pollution levels are always on a surge. Additionally, our public spaces are full of junk, litter, and debris. Our cities have failed to provide enough retreats for the public to refurbish and connect with nature. The differently-abled cannot access our public space and women find it unsafe to be out in the late hours.

As a direct consequence, the upcoming generations are more prone to these mental health issues, all because of a lack of clean and healthy outdoor spaces. When our body receives less exposure to the natural light it starts developing all kinds of illnesses. Urbanisation has given birth to crime, poverty, lack of sanitation, global warming, diseases, population and a frightening competition for a better life. Exposure to these social and environmental adversities has been successful in delivering a constant sense of anxiety among people.

Most psychiatrists suggest going outside in the sun and sit in the greens too for better mental health. However, there are usually fewer green spaces to escape the crowds and be at peace. Privately-owned public spaces like the shopping malls and plazas are often designed and built with ‘world-class’ standards. These places provide an enriched sense of public life but they are privately owned and cater to an exclusive user-base.

Privatized Public Realms

With the increasing population and regressive societal ethos, multiculturalism and socio-cultural stimulations have seemed to have taken a backseat. The non-inclusive public spaces in the contemporary urban life have left many communities suffering from suppression and helplessness; many of which find it difficult to fit into the public life due to differences of race, gender, caste, class or religion. Indian women have been traditionally kept under the strongholds of patriarchal family systems, which often limits their access to public life and their home-bound lifestyle often makes them prone to mental illnesses. Often, they do not receive the social support needed, and hence, their mental distress mostly remains unacknowledged. To overcome this, better placemaking and planning should be adopted, to ensure the sound mental health of the citizens, and more awareness should be generated among the people. The community mental health services and group therapy sessions can be provided by teams including mental health professionals, therapists, social workers, psychologists or any person in the psychology field. Counselling, talk therapy, and cognitive behaviour sessions can make a profound difference. Providing psychotherapy education to the public can also help raise awareness.

Unfortunately, the mental health redressal measures are inadequate in India. There is one psychiatrist to every 40 lakh people in India. Meaning, most people cannot even afford the proper mental health care facilities nor have access to a healing environment.

Moreover, Delhi is estimated to be the world’s most populated city by 2028, and the population is expected to rise up to 37.2 million. Just like most of the South Asian cities, Delhi has a huge disparity in the availability of resources and the surging population. The city needs smart planning and a growth pattern that is in line with the increasing population. Additionally, to achieve an overall improvement in public health, the mental health resources, both in terms of expert medical care facilities and robust public spaces, need be abundant and evenly distributed.

Urbanisation brings along massive opportunities of nation-building through employment, infrastructural development, modernization, economic growth, and mass provision of basic amenities and services, including education and healthcare. The challenge is to check the factors that have resulted in haphazard, unforeseen and ungoverned urbanization over the years, and plan for our cities that could provide a wholesome experience of public life that is refreshing, comforting and vibrant.

------------------------------------------------------------------------------------------------------- Viewpoints: Collaborative Narratives

Rishika Roy | Musician, Vocalist at 'Rooh Unlimited' “What do you do when you wake up one morning in bed, with your brain and body screaming to degenerate. Yes, that's what depression feels like. A deep, crevasse like feeling that's dark and gloomy and sucks you in. And with the kind of lifestyle we live with, it's not new at all. Increased competition, the pressure to be perfect, even 1% of the population, the cream of the crowd is congested and suffocated. With this level of stress, who wouldn't fall into depression sometime or the other? Unfortunately, there is a little we can do, except for being there for each other. I wish I could say India treats mental illnesses the same way they treat broken legs. That child with a limp will get more "Arre beta are you okay?" than that sad girl sitting in the corner who JUST NEEDS CARE!”

Arushi Bradu | Psychologist at Hank Nunn Institute

'Socratic Dialogue in Delhi'

As I set out on my path to becoming a psychologically well-adjusted individual, I referred to the definition of mental well-being provided by WHO and meticulously tried to check everything off. “…a state of well-being in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community.” I was stumped by the last bit of the definition which threw me in a state of contemplation. I wondered what ‘contribution’ entailed and what this ‘community’ business was. Was I supposed to engage in shelling out a part of my income on charity or did it refer to some pro-bono work? At this stage, I realised that that the idea of mental health was so subjective that one might even question the possibility of defining it. Do psychological difficulties refer only to conditions that are diagnosable? What does it mean to be mentally ill or fit? Answering these questions for myself seems insubstantial and answering it for others, biased and vague. This is where I find it significant to encourage discourse and dialogue around issues related to mental health. A community of members belonging to all walks of life; whether it is mental health professionals, people who have no knowledge of what psychological well-being means, individuals who are dealing with mental illnesses and those who aren’t. Chai-logue is one such community. It is an awareness program run by Hank Nunn Institute where individuals gather on two Saturday evenings every month and embark on a journey to explore their own and others’ ideas about the decided issue. The aim is to create a non-judgemental space where there is no authority to explain the binaries of right and wrong. An environment warmed by a cup of tea which never fails to facilitate conversations. It was in one of these Chai-logues that the idea of privilege sprang. The privilege of belonging to a generation that questions, that is aware and constantly willing to change. It is this privilege of ‘knowing’ that I wish people acknowledge. As someone pointed out at a Chai-logue, “With great power (privilege) comes great responsibility.” The responsibility to engage in dialogue when there is a need, to question, unlearn and relearn. Perhaps, we may even consider it our contribution to the community.

Pavani Khera | Psychologist at Hank Nunn Institute

'Am I mad if I see a therapist?'

Stigma can be defined as an attribute that devalues and dehumanises an individual, reducing him or her “from a whole and usual person to a tainted, discounted one”. Seeking help for mental health issues is a difficult decision in our society because of the prevalent stigma attached to these issues.

Most of us are advised to find distractions and find a cure in speaking to friends and family. It is only when the problem gets aggravated to an extent that family and friends can’t bear to have to you around, the person might be pushed towards seeking some kind of help. I have had many patients brought in by their family members who want an immediate solution to cure them of their problem. When they realize that there isn’t any immediate solution for mental health issues and instead it requires work by coming for therapy regularly, they don’t seem to be very happy with that idea. “In our times, there was no such thing. We managed on our own. We don’t know what is wrong with this generation”. As a mental health professional, one needs to frequently encounter such attitude and learn different ways to make people aware of mental health issues and the importance of treatment according to their cultural context. The label of “paagal” is very popular in our culture, and we usually use it in the context of humour. But it is precisely the fear of this label (even in a joking way) that deters people from seeing a mental health professional on a consistent basis. It is okay for you to suffer and seek help for a physical ailment but for a mental health ailment, one first needs to convince others around them that they really need help. It is extremely important to create awareness issues by openly engaging in discussions to normalize the concept of mental health issues and counter the prevalent stigma.

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