Evolution of the Indian Psyche towards Mental Illnesses

In collaboration with Good Lives

To begin with, what is stigma? Being viewed negatively, being disapproved of, or discriminated against. Additionally, what are mental illnesses? Health conditions involving change in emotion, thinking and behaviour. Clinical depression, anxiety disorder, bipolar disorder, schizophrenia to name a few mental health illnesses. This article delves deeper into the origin and spread of stigma around mental health illnesses in India.

Mental health issues in India date back to ancient times. Counselling sessions conducted by Lord Krishna for Arjuna tells us how mental health issues are not a modern issue but an ancient one. Lord Krishna's advice not only resulted in Arjuna's miraculous recovery, but it is also part of one of the most revered ancient texts. Padma Shree awardee and former National President of the Indian Medical Association (IMA), late Dr. KK Aggarwal, regards Lord Krishna as the most celebrated counsellor and Bhagavad Gita to be the first textbook of counselling that has answers to most psychiatric problems. Issues thousands of years old should naturally be accepted in the society and not be expected to have a stigma around them present in modern times. But, that is where Indian society stands.

WHO estimates that the burden of mental health problems in India is 2443 disability-adjusted life years (DALYs) per 10,000 population; the age-adjusted

suicide rate per 100,000 population is 21.1. Even after such a significant amount of people being affected by mental health issues in India, society cannot accept and normalize seeking help. MDE (Major Depressive Episode), is a feeling of tremendous helplessness and worthlessness. Death or divorce, increased stress or a lonely life are the major causes of depressive episodes among Indians. The enduring taboo that has prevailed in Indian society ceases millions in the nation from accessing mental health care. The taboo prevents them from bringing their mental health issues in front of society. Those who even seek help from a mental health professional keep it to themselves, in fear that members of society will not approve of it or accept it.

The culture of society plays an important role in stigmatizing anything, furthermore making it taboo. Well, we are living in a country where often, when you reveal your mental health issues to your family, they might end up consulting an astrologer for you. Who will then suggest a different colour ring for the particular mental health illness, which might not be the ideal solution for the issue at hand. Parents will not take you to a psychiatrist, a psychologist but to an astrologer? This often questions the rationality behind some decisions pertaining to mental health and the mindset of Indian society. It is simply an act forced upon by the stigma that prevails in society when it comes to mental health. In 2018-2019, India was dubbed as one of the most depressed countries in the world according to the WHO. Yet, more than half of the people suffering from mental health issues do not end up getting the help they need in India. The stigma has created an environment in the country where people who seek help from a mental health professional are considered weak, unstable, dangerous or incompetent. But in reality, it may be the opposite.

The belittling of mental illnesses in the Indian context, not having the right terminology to explain your mental state, and thus normalising anxiety and depression in most individuals contribute even more to the excruciating taboo existing in Indian society. The mental-health-related public stigma which reduces hope, lowers-self esteem and often results in social exclusion negatively impacts help-seeking by young people to a larger extent than among adults.

Indian culture is a grounding factor in our beliefs and perceptions, it imposes barriers in the process of destigmatizing mental health in the country. Associating mental health imbalances or issues with religion as schizophrenic patients are allegedly possessed by a bad spirit because of their sins. It is predicted by the year 2030 that depression will be the second leading cause of health disability in the world and this tells us how time- sensitive and crucial mental health destigmatization is.

Despite having the highest cases of depressive disorders in the world (World Health Organization; 2017. Depression and Other Common Mental Disorders: Global Health Estimates.) income inequality is a large contributor to the general lack of awareness and importance given to mental health. Income inequality and poverty helps in understanding the stigma around mental health in India. It is observed that people who live in lower socioeconomic positions or in poverty have an increased risk of mental health problems. Important to point out that it does not mean that members of lower income households have more mental health problems nor does it mean rich people do not have mental health problems. It just means that the risk for developing mental health illnesses are greatly elevated for less earning, less fortunate people. It also suggests that higher national levels of income inequality are linked to a higher prevalence of mental illness.

The future of mental health issues in India may not be decided by the patients themselves, but rather by the society that surrounds them. But if mental health care remains taboo, it will reflect on society, not on the individual. Urgent need for sensitisation of the general public, as well as adequate policy interventions to destigmatize this notion. Awareness campaigns including educational institutions, as well as content that is relevant to culture and age-appropriate social roles, are recommended ways for reducing public stigma. We need to take a new approach with renewed vigour. Progressive government policies based on evidence-based approaches, an upbeat educational system, an engaged media, a responsive industry, and creative crowd-sourcing could all work together to help the country overcome the scourge of stigma surrounding mental illnesses.

Following the acceptance of mental illnesses, therapy, a long standing taboo in Indian society, needs to be broken. ​​Everyone should also be aware of how therapy is not just limited to counselling , but includes art therapy, animal assisted therapy, music therapy etc. It is a broad concept, it has different efficacy for all individuals. Success in terms of seeking therapy also depends on choosing the right type of therapy and therapist. Therapy not only helps you grow overall, but it also empowers you in various ways, helps you develop coping strategies, and provides you with new perspectives on your life. As a result, therapy needs to be available for more and also, be discussed more.

Research has shown a strong linkage between psychotherapy and its positive effect on a variety of mental and behavioral health issues. It is proven to equip one with life skills lasting beyond the course of counselling. Various organisations in India have made consistent efforts to raise mental health awareness. These initiatives help to break down social barriers and make mental health a part of 'the conversation'. Such an initiative is GoodLives. The venture comprehended that a lot of people suffered in silence because they were hesitant to express their sentiments. So, their aim is to fight the stigma against therapy and create awareness. A dedicated team helps in initiating the conversation around emotional wellness, and provides therapeutic assistance from qualified experts with years of experience. The motto of GoodLives is to make mental health services ‘affordable’ and ‘accessible’ across the globe.

Brock Chisholm, WHO's first Director-General, stated, "Without mental health there can be no true physical health”. It was said over a half-century ago, and yet there has been barely any significant progress on that front. Living in the 21st century, it is time that we obliterate the stigma from Indian society and make mental health a priority for all.