MODERNITY'S NEMESIS

"All of us have darkness inside us, and at times it possesses and seduces us in ways we never thought possible."

26-year-old Paramananda Lahajal, a farmer from Odisha, commits suicide by consuming poison on the morning of October 25. Financial crisis drives 45-year-old Batuk Mayad to commit suicide by consuming pesticide at his home in Rajkot. 41-year-old Chester Bennington, lead vocalist of the iconic band Linkin Park, kills himself at private residence after a long-drawn battle with Depression and substance abuse. Adored by all, 63-year-old Robin Williams dies by hanging himself after being misdiagnosed with Parkinson's and falling into a state of Depression.

From Odisha to California, these snippets reflect only one troubling truth – the darkness of mental illness and the cloak of disenchantment does not distinguish the white from the brown, the youth from the old or even the privileged from the needy.

A known enemy, lurking quietly behind the shadows of our glitzy modern-day civilisation, mental illness has carved a careful niche for itself – one that is choking individual happiness and threatening the sustenance of long-term policy development. A recent Lancet Commission report projects that close to 6.5 per cent of the Indian population is affected by mental illness, and this share is expected to shoot up to 20 per cent by 2020 – for a population as proliferating as ours, this would translate to over 26 crore people being plagued by a disease whose recognition and treatment continue to be suppressed by petty evils of stigma and ignorance. To add further distress, over 80 per cent of those affected do not have recourse to the correct methods of treatment. While the problem may seem individual, in truth, its consequence is massively global. Accounting for the financial toll of this crisis, the Lancet Commission predicts that mental health illnesses would cost the global exchequer close to USD 16 trillion in deficit by 2030.

In a few decades, the lack of policy initiative and implementation has amplified a crisis to today give us a bubbling catastrophe. Despite the many reports that are published and voices that share tragic stories of battling mental health crises, engagement and alleviation remain abysmal. A primary impediment has been the lack of recognition – our inability to realise that a deeply personal scare may actually have global ramifications. And, in fact, maybe the very result of our uni-focussed, paced approach to achieve economic growth without paying heed to softer successes in securing happiness within the home. 'Charity begins at home' has probably never held greater scope.

Understanding mental illness

"I recall this one day in 2016 when I was undergoing my worst bout of panic attacks. I was crossing the street and I froze midway. I was panting profusely and I couldn't bring myself to move. I stood there and I cried, without understanding what was happening around or within me," recalls Priyadarshini*, a theatre professional from Mumbai who battled with Depression and Anxiety for two years before seeking help and recuperating.

In everyday parlance, we tend to recognise mental health illness, especially softer diseases such as Depression and Anxiety, as manifestations of the mind, which they largely are. However, in their extensive purview, these diseases will reflect physical aberrations, with panic attacks, breathlessness, sleep discontinuities, eating disorders, mood swings, isolation being the prime symptoms. As Lancet too describes, "....mental health of each individual is the unique product of social and environmental influences, in particular during the early life course, interacting with genetic, neuro-developmental, and psychological processes and affecting biological pathways in the brain."

"For diseases such as Depression and Anxiety, it is important to realise that the phenomenon affecting an individual is not simply a person's weakness or vulnerability. There is a 5 per cent genetic pool predisposition, where certain individuals are created as more susceptible to be affected by certain circumstances than others. Of course, adding to this genetic predisposition is the rapid urbanisation witnessed today, where lifestyle changes have often been too fast-paced for an individual to adapt and cope with," explains Dr Sunil Mittal, consulting psychiatrist with CIMBS who has been practising since the last 35 years.

Therefore, succinctly, to understand Depression and Anxiety, it is first important to acknowledge their existence as real traumatising aberrations clouding existence and, additionally, impeding successful paradigms of development. They aren't conjured; neither is it 'just a phase'. They require deliberation, assistance and an immediate removal of stigma to pave the way for a society that is happy – indeed, without happiness, every other parameter of success will fall flat on its face.

Coping with mental illness

"Mental ill-health is the illness of the brain and it demands attention; you can't ignore it and expect it to go away. Talk to a doctor, or a friend or even your family, as I did. You must recognise your problem first, it lies within you and you have to take that first step," says Rahil*, a 24-year-old social networking advisor from Bengaluru, whose bout of Depression surfaced at a time of deep professional crisis.

Rahil* highlights the importance of taking that first step in the right direction. Agency becomes critical, and this isn't just for mental illness, it would apply to everything else – whether stomach ache, headache or heartbreak – one has to first recognise that an element of normalcy is clearly displaced and only thereafter can corrective steps be rationalised.

Recognising a disease though isn't always easy. Unlike palpable physical diseases, mental illnesses have subtle undertones. "In a warp of fear, my mind kept insisting that every action I took would come with an alternate repercussion. If my shoes weren't properly aligned, I would panic that something bad would happen to me. I would latch on to the slightest instance of grief and never let go. There were endless nights of howling and locking myself in a dark corner, until I realised that I had to take a grip on my life," says Devika*, whose encounter with child sexual abuse had given birth to insecurities, which, over time, housed irrational fears that eventually led to a mental disability.

Devika* never sought help from the outside; her mechanism involved self-healing and improvement. Though she continues to battle deficiencies, she is admittedly in a better place today simply by acknowledging that something wasn't right and taking several extra steps to ensure that the wrong is put back in its place.

"Awareness and stigma are universal barriers impeding the progress on the front of mental health treatment. Going to a psychiatrist isn't an indication of madness –this message has to reach the people. Let the doctor ascertain your condition. Yoga and meditation are useful for mental well-being, but not for mental illness – that demands medical attention," asserts Dr Mittal, remembering his many instances of treating and convincing patients who have been restricted by preconceived notions of 'madness'.

Challenges to mental healthcare

In an optimistic move, India had passed the Mental Health Care Act in 2017, "..to provide for mental healthcare and services for persons with mental illness and to protect, promote and fulfil the rights of such persons during delivery of mental healthcare..." While a positive first step towards the recognition of mental health concerns, the follow-up has been miserable. Depression and Anxiety continue to plague urban metropolises, with suicides running unchecked through both rural and urban setups. Psychiatrists are still numbered, with less than 5,000 registered practitioners (psychologists, counsellors, psychiatrists) across the country, concentrated largely in big metropolises and cities. About 2/3rd practice in the private sector, whereas 50-60 per cent patients seek help from government bodies. Evidently, the mental health gap is huge.

Earlier, health insurance did not include mental illness in its purview. Though a recent judgment has asked insurance companies to provide provisions for mental health support, challenges remain. The subtlety of the disease, its variable and often unquantifiable symptoms, and its deeply personal essence make it challenging to provide insurance coverage – an essential requirement as costs can escalate in light of prolonged treatment that often forms the basis of mental health recuperation.

While policies and acts are formulated at the level of the State – on the ground, initiatives are restricted in their scope, stigma continues to loom large and worldly disillusionment is only being amplified with each day's quantifiable progress.

Journey to nadir

In a matter of a few decades, how did we reach here – from seemingly happy, motivated, ambitious people, albeit spruced with our individual challenges, how did we pave the way towards becoming isolated, bonded individuals, able to express apparent happiness only on our glossy social networking pages?

"Now that I look back, I think the answer is capitalism. I always wanted to do what others seemed happy doing. I wanted to be a part of the clique, have the shiniest objects, a heavy bank balance – the chase had no end. In the process, I lost my essence, who I am and what I want," Priyadarshini* says what most today will agree to.

While we humans of late capitalism have gained endlessly from technological innovation and digital growth – we have lost aspects of ourselves that are difficult to revive. Capitalism taught us to let go of the bonded past, boundaries and mindless mediocrity – to pursue the best and never settle for the average – but what if one's average is someone else's zenith. With the standardisation of goods, we have attempted to standardise human pursuits – a grave error that is coming back to haunt our society with evil undertones. While it is essential that we chase excellence in our respective fields, the idea of excellence cannot be reduced to numbers, awards or even appreciation on social media.

The battle against mental health illness is not a fight alone for psychiatrists with patients, or families with children or for individuals with their minds – it is a social crisis emanating from the society that we have so carefully developed so swiftly without taking care of our homes. It requires intervention by each individual to realise that mindless trends of digital networking must be restrained, governments must understand that no parameter of development will be meaningful unless citizens can be happy and secure, policymakers have to come on the ground and mediate between State decisions and ground implementation, parents have to nurture their children as rounded individuals before successful professionals and discourse on deficiencies has to be a way of life. Only knowledge can beat ignorance, awareness can beat stigma and a shared community can help struggling individuals overcome their battles of perceived isolation and distress.

*All characters are real, names have been changed to protect privacy.