In the summer of 1982, when Radha (name changed), 15, a convent school student from the village of Peringad in Kerala had a tussle with her neighbour, she was deeply troubled. Anxious that the allegation of theft levelled by the neighbour against her would affect her image as a school topper, Radha went through immense stress and trauma. Her family tried its best to resolve the dispute with their neighbour but Radha had begun developing self-esteem issues. Soon, neighbours and villagers started spotting her sitting alone on top of a haystack. When whispers about her behaviour grew louder, the family decided to take matters into their own hands and seek help. Radha’s family, which belongs to the socially and economically backward community of fisherfolk, was deeply skeptical of meeting an allopathic doctor. “At that time, treatment meant electric shocks, which were equivalent to being seen as a mental patient forever. So, they decided to approach a sorcerer to ward off evil spirits from her body,” a close relative of Radha told Tehelka. “For two years, the sorcerer tried every method, including animal sacrifice, but nothing worked. Finally, we took her to an allopathic doctor. There, the doctor administered electric shock (electroconvulsive therapy) on her, which brought about a slight improvement in her behaviour. For instance, she could recognise her uncle. However, her brain never grew afterwards; mentally, Radha remained a 15-year-old ever since.”
A conversation about depression is akin to stepping on a minefield even when it is Deepika Padukone who is speaking about it on national television. It isn’t simply because of India’s failure to recognise and accept depression as an impediment to the wholesome mental wellbeing of an individual. One of the reasons for depression being at the centre of such an important yet ignored debate in India stems from its existence outside of the medical definition of ‘diagnosable’ due to a lack of visible symptoms.
Home to the highest number of suicides (in 2012, according to a World Health Organisation report), India has much to worry in terms of mental health. There is a disdain for anyone who strays away from the ‘normal’ path. Parallelly, factors such as economic backwardness and physical and sexual abuse at home have contributed to a spate of suicides. In such a scenario, sexual and religious minorities, oppressed castes (more often than not Dalits), women and children bear the brunt of a system that is discriminatory in nature.
In a study (2014) published by the Journal of Mood Disorders, authors Sameer Dhingra, Mamta Sachdeva and Milind Parle attempted to examine some factors responsible for depression in Haryana. Outlining the prevalence and cause of depression through retrospective analysis of medical records from 2010 to 2013, the authors cited socio-economic variables as an important factor behind depression. While the report found elderly women from socially and economically backward communities of the Hindu community the most depressed, it also cited how depression had the tendency to increase with age and medical conditions.
Similarly, in a 2007 study conducted in southern Tamil Nadu, authors Ramaswami Mahalingam and Benita Jackson found that “idealised caste beliefs and chastity [were] seen positively with respect to self-esteem. In addition, shame positively related to depression and this relationship was stronger for women than men”. In other words, internalising cultural ideals, including participating in patriarchal and casteist networks that uphold historical discrimination, enabled women to construct a positive sense of selfhood as compared to resisting these ideals. That is, any attempt to resist these ideals often compounded shame and guilt in women more than men.
While this study primarily explored women in village communities, the implications of the study also fall upon women in urban spaces where any attempt to thwart existing networks of patriarchy and caste have accentuated doubt, shame and guilt.
SPK Jena, an associate professor of applied psychiatry at the Delhi University, says, “Let us decode the myth that women are weak and more depressed. Women are not necessarily more depressed than men. It is not a universal truth that they suffer from depression more than men. In fact, it is society, culture and economic background that become the deciding factor. Here, women are more often than not treated as faults and less as human beings. They are assigned multiple roles as well but because they are conditioned to only perform, any failure in fulfilling those responsibilities would lead to tension.”
In a first person account to Tehelka, an Indian filmmaker and poet based in Tamil Nadu, outlines some of these concerns when she talks about her struggle with depression. “I have tried four times to end my life … once I had 50 sleeping pills and almost lost my sight but not my life. Every time I lost it, I had to go through this terrible process of oral enema where they forcefully inserted a pipe inside my throat to make me vomit and I cursed myself for not trying enough,” she recalls.
“Trying to kill oneself happens in that extreme moment of helplessness and desperation. Depression is one’s own black hole. Being an outcaste both in my family and in the society, for I gave no birth — I am a daughter to none and I will be no one’s wife — I could not seek help from the sources that were the reason for my depression. Being autonomous is being abnormal and failing in my roles as a woman. Sometimes, I wonder if we were genetically encoded with a guilt factor. It is always about ‘what others think’ for a woman,” she adds.
In 2012, the WHO recognised depression as the leading cause of disability worldwide. It noted that depression had affected an estimated 350 million people across the globe i.e. an average of one in 20. The WHO had called for a substantive action for combating depression. As a result, the 65th World Health Assembly had mooted a global initiative from its member states so that efforts could be made for initiating and expanding mental health care services. Subsequently, in 2014, when Harsh Vardhan was the Union health minister, India’s first mental health policy was launched to provide universal psychiatric care. Seeking to include psychiatric care in the primary health sector, the policy called for decriminalising attempt to suicide. Additionally, the policy highlighted the need to allocate more funds for opening departments for patients in need of psychological and psychiatric health care. However, the state of infrastructure and funding remains sad: India spends less than one per cent of its budget on mental health. At the level of infrastructure, India has 43 mental health facilities i.e. 0.004 per one lakh population. At the level of the workforce, the country has only 0.301 health professionals per one lakh people.
It is in this alarming state of affairs that women like Radha, for instance, find cure in black magic. In cities, however, private psychiatric hospitals and professionals have opened a route of access for those who cannot afford expensive health care facilities. “I wasn’t aware that I could get depressed. I assumed it as mood swings. When it took a toll of my physical health and relationships, I began consulting a psychiatrist. I took medical advice, pills and sought naturopathy, Siddha and Ayurveda camps,” says the Chennai-based filmmaker.
However, accessibility alone does not further the cause of helping out those suffering from depression. For instance, soft skills trainer Deepika Shanmugharaj, 25, tells Tehelka about the failure in identifying depression. “I have been in a situation in my profession where I was denied my rightful promotion just because I am a woman. The fact that I was denied promotion was devastating for me as I firmly believed that I would get promoted,” she says.
“I was frustrated to an extent where my ego pushed me to quit my job immediately. My family, which initially supported and motivated me, slowly started to show intolerance as I couldn’t be as cheerful and entertaining as I used to be when I returned from office. My mother decided that I am not capable enough to sustain and excel in my profession and so she started looking for the possibilities of getting me hitched.
There are multiple variations of depression that a person can suffer from, with the most general distinction being depression in people who have or do not have a history of manic episodes.
♦ Depressive episode involves symptoms such as depressed mood, loss of interest and enjoyment, and increased fatigability. Depending on the number and severity of symptoms, a depressive episode can be categorised as mild, moderate, or severe. An individual with a mild depressive episode will have some difficulty in continuing with ordinary work and social activities but will probably not cease to function completely. During a severe depressive episode, on the other hand, it is very unlikely that the sufferer will be able to continue with social work or domestic activities, except to a very limited extent.
♦ Bipolar affective disorder typically consists of both manic and depressive episodes separated by periods of normal mood. Manic episodes involve elevated mood and increased energy, resulting in over-activity, pressure of speech and decreased need for sleep.
Source: Department of Mental Health and Abuse, WHO
“The stress in my professional life slowly started to grow into depression. I started to underperform in my work and I couldn’t maintain a healthy relationship with my family. Later, I managed to get another job offer which brought things back to normal in my life. I never sought help from a professional in the field of psychology because we Indians have a stereotype that one would consult a psychiatrist or a counsellor only when he/she has a chronic mental disorder. In fact, I had no idea that I was depressed at that point of time and when I finally realised that I had been through depression, I had already overcome it.”
Any engagement around mental health care must also be inclusive of the women in the show biz industry. Though some critics might accuse Deepika Padukone of pulling a publicity stunt, stars such as Parveen Babi, Meena Kumari, Jiah Khan and Silk Smitha stand as examples of women who succumbed to the pressure of mental illness. While Parveen Babi reportedly starved herself to death, actresses Jiah Khan and Silk Smitha committed suicide due to relationship troubles. Meena Kumari, on the other hand, had succumbed to liver cirrhosis due to her longstanding drinking problem coupled with depression.
However, a disturbing aspect is the denial of access to adequate health care — both physical and mental — to the sexual minorities, who most often face repression from law and family. As a result, any attempt to heal on their own or through guidance from counsellors and psychiatrists is virtually impossible. For example, the Section 377 of the Indian Penal Code that upholds criminalisation of sexual acts against the order of nature has been often cited as a necessity to contain ‘health hazards such as aids and HIV’. This has, therefore, abetted a vast number of undocumented suicides amongst sexual minorities and stigmatised the community by and large.
Although the Supreme Court did create the ‘third gender’ status for transgenders, prejudice and discrimination against transgenders continues. In an article published by the Journal of Indian Medical Research, authors Suresh Bada Math and Shekhar P Sheshadri note, “The disparity of health care for sexual minorities exists in all societies. For instance, most often, transgenders are not even allowed inside hospitals in India. They are not allowed inside educational institutions and find it difficult to get a house on rent. Subsequently, many of them do not get social or disability pension, voter ID, passport or even a caste certificate.”
On 28 December 2014, when an American transwoman Leela Alcorn committed suicide by walking into oncoming traffic, her suicide note criticising her family in abetting her death went viral. While the note poignantly stated Alcorn’s grief at being outcasted, the last few sentences succinctly put the question of mental health and society together. “The only way I will rest in peace is if one day transgender people aren’t treated the way I was, they’re treated like humans, with valid feelings and human rights. Gender needs to be taught about in schools, the earlier the better. My death needs to mean something. My death needs to be counted in the number of transgender people who commit suicide this year. I want someone to look at that number and say ‘that’s fu**ed up’ and fix it. Fix society. Please.”
With inputs from Neetole Mitra in New Delhi and Nisha Ponthathil in Chennai