“There are 3 things you need to do: 1) become more religious, 2) find more friends, and 3) do a little more exercise”.
This is what I was told by a certified mental health practitioner in Hyderabad a few years ago, when I finally agreed to go see someone after acknowledging I may have a medical problem of depression.
Mental health in India is viewed largely as a first-world phenomenon: a consequence of modern lifestyles, of problems that are somehow inherited from the west. It may be part of a cultural superiority complex: where going to a mental health professional was viewed as something done only by the bourgeois who had the luxury of both time and money, but lacked a strong family support system. Like so many of our other social ills, an admission of the existence of mental issues may threaten to reveal the weaknesses of our culture and the ancient traditions that we are so proud of.
This frame of thinking had seeped into my subconscious in such a deep way that I failed to recognize the presence of clinical depression both in my mother, as well as myself. I suffered through it for many years, and only after much persuasion by close friends did I finally agree to see someone. I had been fortunate to have had a quality education and had lived in the west. But breaking out of mold of what society had ingrained regarding mental health, even for me, took too long. Convincing my mother to do the same has been another uphill battle.
Society made us view depression primarily as a consequence of our failures, but not as a cause.
In India if you take a person to a psychiatrist, it is thought they must be totally crazy. And if you go to a mental health clinic, you may in fact be reaffirmed about this—when I looked around the waiting room I could only see extreme cases. And why wouldn’t this be so when there are only 37 mental institutions in our entire country of 1.2 billion!
In reality, the prevalence of mental health issues in India is widespread—according to the WHO, depression affects one in ten people in India, and has the highest rate of major depressive disorder in the entire world. In fact, an estimated 75% of people affected by mental disorders live in low and middle income countries, and up to 85% of them do not have access to any treatment. And given the stigma associated in reporting, this is most likely an underestimate. This is clearly not just a rich world problem.
Low income, great uncertainty about the future, and high risk on a daily basis—those would put significant pressures on the mental health of anyone. While yes, strong family and community bonds may help counteract some of these stressors, it is certainly not always the case. The conventional wisdom is that treating depression in countries where there are so many other problems is a luxury.
But if depression can paralyze people who have everything, how can we ever think that it cannot affect people who have nothing?
It is our outdated framework of viewing mental health for why it gets the short shift in public health spending. India spends only 0.06% of its already small health budget on mental health. By comparison the US spends 6%. Almost a third of countries do not even have a specific budget for mental health. As a result, low and middle income countries have 200 times fewer psychiatrists than high-income countries. What is needed is a drastic change in our perception of the problem, a wide recognition of its crippling incidence and an acknowledgement of the investment needed to even begin to address mental disabilities in our society.
I left the office of that same doctor that day thinking I would not be going back. I did eventually go to someone else and only in hindsight can I acknowledge how critical that was. But it is hard to imagine how much more difficult it would be for the millions without the same access, that are silently suffering. Now that is a depressing thought.
Kshitij is a diligent cog in the World Bank machinery. To manage his emotions, he jogs.