Mental health’s struggle to finally gain visibility and acceptance

Mental health’s struggle to finally gain visibility and acceptance

The pandemic brought with it enough anguish and suffering that was hard to dismiss. People had no choice but to finally accept and acknowledge that mental health is an important issue that needs immediate attention.

Namrata Gupta

The last two and a half years have been unsettling, disturbing and nerve-wracking for us all. Globally, the world was tossed upside down. COVID-19 struck each of us, sparing not a single person. People had emotional meltdowns, their daily life was disrupted, they faced loneliness and isolation, fear for life, their plans and aspirations were shaken, and were plagued by incessant economic worries.

The word Covid brings out varied reactions in people. Some feel sad, others worried, and don’t be surprised if someone just breaks down at the mention of the word Covid. Conversation among friends takes an extremely personal turn in no time.

Disbelief about loss

Dr Dhruv Mahopatra (name changed for anonymity), a surgeon for over two decades reached out for professional help as he was experiencing symptoms of grief, which came with tides of sadness, anxiety and disbelief that his elder brother who was also a doctor lost his life due to Covid complications. Dhruv was unable to contain his sadness. He had questions about his own emotional response and what he was experiencing. Being a doctor, he had witnessed death since the first year of medical training, which confused him more, and his emotional vulnerability and breakdowns knew no bounds. He was also hesitant of being judged by his colleagues and friends as weak and impractical, but with encouragement from his family sought professional support and treatment.

There have been many such instances where anxiety, depression and post-traumatic stress disorder have taken over, leaving an individual absolutely brittle and vulnerable. Mental illness like any other medical illness can impact any individual, the etiology is multifactorial.

Being mentally healthy isn’t only equivalent to being illness free. The World Health Organization (WHO) conceptualises mental health as a “state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community.”

Photo Credit: Namrata Gupta

Lasting impression

Around the beginning of my career in Psychology in the early 2000s, I came across findings of Global Burden of Disease Study, while reading one of my course books. The findings enumerated highlights of estimated ‘disease burden’ of depression alone to society. Depression ranked among the top five health conditions in terms of years lost to disability in all parts of the world except Africa then. Today, even after 20 years and till date, I haven’t been able to forget what I read. It left a profound impression in the way I looked at mental illness since then, awareness that depression as a health condition ranked above heart disease and strokes, worsening one’s quality of life and increasing disability-adjusted life years.

In my day-to-day clinical practice, where I meet many individuals and families suffering from mental health conditions, the common parlance is that all mental illness is depression.

The fact is that depression is one of the mental illnesses. It is a spectrum on which the nature of symptoms, duration, and severity are all important factors to consider for the right diagnosis and treatment.

Before I go further, it’s important for me to state that the person and diagnosis are not the same. It is not about labelling an ‘individual’ but to correctly diagnose the illness and provide timely treatment.

Among the top 10

The findings of Global Burden of Disease study 2019 showed that mental disorders remained among the top 10 leading causes of burden worldwide, with no evidence of global reduction in burden since 2019 (Lancet 2022).

According to a recent scientific brief released by the WHO, on 2 March 2022, the COVID-19 pandemic has triggered a 25% increase in the prevalence of anxiety and depression worldwide.

With steady advances in medical knowledge and its use, numbers linked to disability due to physical illnesses has shown a significant downward trend. However, the same cannot be stated for mental illnesses.

The gap between the need for treatment and mental health care providers is wider than what we can overcome in the near future without suffering further damage.

The Mental Health Atlas put forth by the WHO in 2017 stated that India has 0.29 psychiatrists for every one lakh individuals. The number is worse for psychologists, with only 0.15 psychologists available for every one lakh individuals. In all, 1.93 mental health workers are available per lakh population.

Pandemic for all of us has had a detrimental impact undoubtedly. And it isn’t over yet.

Here to stay

According to recent researches, COVID-19 is an ongoing traumatic stress. It is continuous, ongoing and with no end in sight. The impact of COVID-19 has been postulated by researchers as a continuous ongoing trauma (type III trauma, Kira, 2021). For each one of us COVID-19 has had a very personal and lasting impression and it continues to do so.

Every person has a personal story to live with, in the years to come. It is anything but simple, keeping in view the infection, the various variants, growing co-morbidities, but also the significant impact on one’s mind and body health, spiritual well-being and overarching long term consequences, which are yet to be understood fully.

Restrictions, curfews, limitations on free movement, social isolation, surmounting pressure of daily life, limited resources, daily flash of bad news across television screens and other forms of media, disrupted family life and relationships, sharp rise in reports of violence, addiction and suicides are high. We are living a pandemic, in the middle of an ongoing war and global crises.

COVID-19 has impacted our health care systems severely, not barring delivery of mental health services.

But, as we have time and again witnessed, the grit and resilience of human spirit finds a way and means to rise above all despair and come together to overcome the unknown. In times of such odds and baffling circumstances, so many of us did find a means to support one another, that one helping hand, that one call, or just strangers extending the much needed support.

Breaking the stigma

Covid has acted as a propeller pushing us worldwide to pay greater attention to what has been moving at a snail’s pace until now. Finally, mental health has begun to gain attention like never before, lowering stigma, coming to the fore from the margins.

The younger generation, especially has been trailblazing, breaking the heavy chains of stigma, not just by coming forward to seek help professionally, but having difficult conversations within their families, bringing about a change in generations of ongoing inter-generational trauma. With my experience through the pandemic, it’s easy to say that our attitude towards mental illness and its acceptance has changed. We are becoming more open to talk about it not just in our close circles but also with our families and extended social groups and communities.

So, does it matter how others think about us? On the surface a majority will say ‘no’ but we know this isn’t the case. Biases and judgements matter to us so much that we are ready to go through days and months of ill health and doom, but not seek treatment.

The current circumstances we are living in, has compelled us to look at the realities we have managed to remain ignorant about so far, but not anymore.

Why is seeking treatment for mental health still looked at with perplexed expressions and taken as a sign of defeat? ‘Dimaag ka khel hai’, ‘psychologist kya karengi, doctor davai dengae’ are the usual responses. We don’t think twice before putting wrong food into our bodies, indulging in habits that are evidently damaging for our bodies, and giving into wrong choices, indulging in ‘desi nuskhae’, visiting, astrologers, pandits and alternative healers for professional advise?

If sharing about a heart condition isn’t looked at with stigma, and diabetes mellitus is recognised as a lifestyle issue now, why can’t we, with the same ease, accept mental health concerns and seek timely professional help, thereby reducing the burden of illness and its long term impact.

I often use the example of a three legged table to explain the importance of bio-psycho-social model for the etiology and treatment of mental health conditions. Just as any medical illness cannot be treated alone by an isolated change, the same is true for mental illnesses.

Contacting a credible professional for advice is the first step forward. Telemental health is an important step towards early detection and timely treatment. It is important to consult a trained and recognised mental health practitioner. Accepting what we see on social media as professional opinion isn’t recommended, in the same way as you would not get a broken ligament repaired online over social media!

Recommendations / Changes we all may reflect on and make:

  • Remember, we are a collective society, but not at the expense of individual well-being. Striking a semblance of order over time is the key to achieving better mental health.
  • Self-check-in throughout the day, making it a ritual respecting your well-being. Ask yourself how you are feeling, what is it that you can do for yourself, and what is it that you need to prioritise ‘now’?
  • Keep a check on your inner chatter. We are our worst critics. So, we forget to cherish ourselves, and berate and become harsh over the slightest mistakes we may have made.
  • Be alert for any signs of continuous and significant irregularities in mood, sleep disturbances (less or more), changes in appetite (both less or more), changes in the upkeep of personal hygiene and social interaction, and alterations in fulfilling roles and responsibilities at home or work, which were being fulfilled effectively before.
  • Indulge in small acts of self-compassion on a daily basis. This will certainly do you good in the long run.
  • Drawing constant comparisons has never done any of us good. Let’s start by being gentle to ourselves.
  • With overarching daily demands, we need to start drawing a line for ourselves. Learn to gently say ‘no’, when situations or people are placing their demands heavily on you.
  • Hustle culture has been made popular and is highly overrated. It’s not for everyone and certainly not all the time. Slowly learning to unwind, focussing on slow breaths, pacing down, and taking one task at a time is a good practice to start with, and helps to manage the feeling of being overwhelmed and anxious.
  • Be reasonable while setting up your schedule, ambitious planning of schedules only leads to disappointments and despondent feelings spreading over the day and increasing self-doubts. Asking a simple question as to what’s important at this moment is an important self-practice towards living mindfully.