Mind your matter
Depression is a fast growing epidemic that claimed its latest star victim when TV actress Pratyusha Banerjee hung herself at her Mumbai residence. Psychologists tell SHALINI SAKSENA that increasing stress levels, lack of family support and the stigma attached to mental health are major contributors of increasing mental fatalities
Television actress Pratyusha Banerjee’s recent suicide, allegedly because she was depressed about lack of work and a relationship gone sour, highlights the fact that the nation’s urban population is under a lot of stress. As it is, Indians are deluged with several other lifestyle diseases like obesity and diabetes. Add to that the mental monster of depression waiting to strike with its mouth wide open and the picture turns scary. From being considered something that one could handle by just snapping out of it, to this life-taking and fast growing urban epidemic, the jump has been much too fast and alarming.
The alarming thing is not just its epic proportions. Doctors say that depression is getting as younger as it is getting older.
This is not the first time that a celebrity has committed suicide due to depression. Over the decades, Bollywood has been punctuated with shocking suicide tales. Actor-director Guru Dutt, who gave films like Pyaasa, Kaagaz Ke Phool and Mr & Mrs 55, died after consuming sleeping pills with liquor way back in 1964. The reason for his death was apparently his deteriorating relationship with wife Geeta Dutt, a singer, and his love for Waheeda Rahman who had distanced herself from him. It is said that he had attempted suicide twice before. His wife, too, had a nervous breakdown and finally died of liver cirrhosis in 1972 at age 41.
Then there was the much publicised case of south Indian sex symbol Silk Smitha who hung herself in her house from a ceiling fan. Her suicide note said she was taking this drastic step because she had failed at everything.
Supermodel and TV actress Kuljeet Randhawa also ended her life by hanging herself. Her suicide note said that she could not cope with the pressures of life.
Former Miss India and TV actress Nafisa Joseph hanged herself in her apartment in 2004 because just a few weeks before her wedding, she discovered that her husband-to-be was still married when he had said he had been divorced.
On February 7, 2008, actor Kunal Singh was found hanging from a ceiling fan in Mumbai. His claim to fame was his movie Dil Hi Dil Mein opposite Sonali Bendre. Though he was doing well professionally, his bad relationship with his wife and the fact that he was not allowed to see his children pushed him to fatality.
Of course, one can’t forget Divya Bharti who was just 19 and sitting atop a handsome career when she fell from or jumped out of her fifth floor apartment window in 1993. Some said it was suicide because of a broken heart and others speculated about it being accidental.
More to our times was Jiah Khan who starred in Nishabd opposite Big B. The actress was found hanging in her Juhu apartment by her mother and sister. She killed herself because she was depressed about failure at all fronts.
Clinical psychologists, like Dr Pulkit Sharma who works at the Imago-Centre for Self in the Capital, tell you that the problem has assumed such large proportions due to increased stress levels, lack of family support and timely treatment.
“People today are on an ego trip and unable to handle any situation of pressure or failure. They just give up in. Celebrities especially are vulnerable. This is because once they reach the top they are under constant threat that somebody else will take their position. If a few of their movies fail it adds to their stress levels,” Sharma says, adding that the inability to cope with problems is a major reason for depression.
Dr Manoj Kumar Sharma, associate professor, department of clinical psychology with NIMHANS in Bangalore, says that today, the coping behaviour in the environment comes with a fixed solution. “We don’t work on an alternative and if the solution doesn’t give the required result, people see it as a failure and they become pessimistic. They feel hopeless and see no other way out but to end their life. Here, personality factors play a role. Suicide is a state of mind driven by impulsiveness. If a person has been brought up in an environment where there are options, he develops resilience to adversities. Those who don’t have a good support system or their developmental stage has been affected due to circumstances, they can’t cope with failures. Also, it has been found that consumption of alcohol increases suicidal tendencies because depression combined with drinking affects the person’s judgment,” he explains.
Why is it that we are unable to cope with failures? Earlier, there was a strong support system wherein people could communicate, discuss and ventilate their feelings with each other. This helped them relax.
“In today’s digital world, most of the conversation is happening online. There is very little personal connect. People, instead of being in a group, are becoming more individualistic. The group association and identification is being lost and if things don’t work, the only option is to end your life. Also, there is too much expectation to excel. Our parents and society put a lot of pressure on us to be the best all the time. The expectancy level gets ingrained in us from childhood and this gets reinforced as we grow up. We start to internalise those expectations. We say that we must allow a child to chart his own path but this is governed by expectations. If there is a failure it disturbs you and that contributes to hopelessness, finally leading to depression,” Kumar says.
Incidentally, India has the world’s highest suicide rate among 15 to 29-year-olds, ahead of North Korea, according to a WHO report of 2014. Data released by the National Crime Records Bureau said that at least 15 suicides took place every hour in the country in 2014, which saw over 1.31 lakh people ending their lives, with Maharashtra heading the list of such cases and Chennai doing the same in the cities section. The rate of suicide in cities was marginally higher at 12.8 per cent as compared to the all-India suicide rate of 10.6 per cent, the report added. It said that ‘family problems’ (other than those linked to marriage) contributed to 21.7 per cent suicides. As for the patterns, 41.8 per cent committed suicide by hanging, 26 per cent by taking poison, 6. 9 per cent by self-immolation, 5.6 per cent by drowning themselves and 1.1 per cent by jumping off buildings or in front of trains.
But why is depression creeping up the epidemic ladder? Chandrashekhar Tiwari, consultant clinical psychologist with VIMHANS, Delhi, tells you some reasons for this.
“First, lack of awareness among the people. Most people feel aise he theek ho jayengey (they will get better on their own). Second is the social stigma attached. People, especially in the corporate set-up, don’t want a stamp of mental health problem. Many say, ‘we will pay you whatever you ask for, but please come for a home visit. What if someone recognises us? We don’t want to come to VIMHANS’ they say,” Tiwari tells you.
This thinking stems from how people view going to a psychologist. They think they are mad and, hence, need treatment. While this is a very basic explanation for the stigma that we have in our society, the problem lies in lack of awareness.
In order to tackle this illness, he tells you that there is urgent need to increase awareness at all levels. “According to WHO, the prevalence of depression is 20-26 per cent among women and eight-12 per cent for men. But in India this figure stands at 30-35 per cent. Also by 2020, depression will be the second largest cause of disability,” says Tiwari who sees two to three patients with this illness daily.
In such situations family support is extremely important. A depression patient has mood swings. So, while the physical appearance may not indicate that there is a problem (he will go around doing normal things like shopping etc), the truth is that he is suffering. Considering that depression has three stages — mild, moderate and severe it is important for family and friends to realise that the patient needs medical intervention and that what they consider ‘woh drama kar raha hai’ is actually a serious problem that will not go away on its own.
“In mild depression, there are no physical symptoms. It is in severe cases that one can see the manifestation. In mild to moderate cases, one won’t even come to know that the person has any problem,” Tiwari says.
So, what exactly is depression? It is a real illness that impacts the brain. The WHO characterises depression as one of the most disabling disorders in the world which is more common in women than men. Anna Chandy, a well-known Bangalore-based family counsellor and chairperson Trustee of The Live Love Laugh Foundation, tells you that clinical depression is an illness that is neither restricted to a certain class of people nor is it area centric. It is an illness of the brain and the cause is far more complex than a singular factor.
The Indian Government woke up to the fact that there is a problem and, in October 2014, released a mental health policy with a call to increase spending. For now though, India spends a mere 0.06 per cent of its small health budget on mental health. This is not surprising since there are few who want to talk about it and fewer still who go for treatment.
The result is that for every 100,000 Indians between ages 15 and 29, 36 commit suicide annually, the highest rate among youth in the world.
The reason why this age group is more prone to depression is because the stress levels among people in the ages of 15 to 45 is considerably high. When we talk about the scientific causes, it relates to mood-related chemicals such as serotonin. This is genetically linked and people are predisposed towards depression since birth. But for this to precipitate, stress is a trigger. However, it all depends on the support system as well.
If that support is not there, depression can turn into a life-taking problem. There have been instances where the husband doesn’t even want his wife as a caregiver. They don’t want to discuss or even talk about it. This is because there are some people who stop talking to people with depression; such people then feel isolated which only adds to the problem. In the private set-up, companies may want to get rid of an employee with depression; one is seen in a negative light so people with depression go into a shell and avoid talking about it thinking that they will manage it on their own.
“The sad part is that people with depression come to VIMHANS only when primary and secondary form of treatment has failed. If they came at an earlier stage, the treatment medicine with cognitive behavioural therapy does wonders for the patient as the recovery is fast if the patient is motivated,” Tiwari asserts.
The fact that we are no longer content with what we have is another contributor to depression. “There is lack of peace in our lives. ‘We live in a competitive world and there is need to better ourselves all the time or someone else will take our place’ is the perception in our mind. The level of insecurity among people in the private sector is very high because they feel that there are fewer resources and there are others to take their place hence they need to work even on Saturday-Sunday,” Tiwari says.
The reason why only a few are unable to cope with high societal expectations and commit suicide is because suicide in itself is complex and it is not caused by a singular factor. “The ability to cope with societal expectations varies from individual to individual. An individual’s ability to cope with stress and societal expectations depends on his or her personal sense of psychological adequacy and worthiness and the availability of support systems during difficult times,” Chandy says.
The Mental Healthcare Bill proposes a series of progressive clauses, including a provision that persons who attempt suicide will now have the right to confidentiality of mental healthcare information. Under the new Bill, the State is required to take responsibility for the implementation of programmes for promotion of mental health and prevention of mental illness and suicide. Attempting suicide is currently an offence under Section 309 of the Indian Penal Code that can attract punishment of up to one year in jail and a fine. But is this enough to curb an urbane epidemic?
“The Bill is the need of the hour. But what we need more is to work at the community level and the public health domain to raise awareness, both for the parents and children. We must have an environment where we can discuss our problems; at home, in schools and forums so that people become sensitive to this ailment and facets related to changed behaviours. If we are able to do this, it will automatically bring about a change in the person and how they think,” Kumar says.
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