There is a deep rooted stigma that prevents people from seeking help or sharing their story. If not caught on time, it can lead to serious implications, writes Dr. Prerna Kohli
The recent events have drawn a lot of attention towards mental health and made us understand how pervasive depression is. Many of us need to have a clear understanding of depression, which is very different from temporary low moods or bad moments. Depression is a state of low mood and aversion to activity. It makes one sad, helpless, worthless and one can also be irritable, antisocial and feel ashamed. It’s a deeper feeling of sadness and people who are clinically depressed cannot simply will themselves to feel better or snap out of it. It leads to a variety of emotional behaviour and causes physical and thought problems. It decreases the ability of the affected to function at work and at home. It can also cause irregular sleep patterns, weight loss or weight gain. If one feels lonely and helpless, thoughts of suicide can occur.
Mapping the disorder
Several factors play a role — certain chemicals in the brain may contribute to depression. It could be genetic too, passed on from families, down the line. If someone suffers from low self esteem or is stressed, then depression is more likely. It could be a personality type as well. Pessimists are more prone to depression. We also cannot discount the contribution of external factors, especially in these troubled times when the entire world is dealing with an unprecedented event.
Depression can be triggered by external factors as well — such as violence, neglect, abuse or major events like losing a job, divorce. In certain cases, even medication can play havoc. Substance abuse too can play a big role. If you are addicted and have a constant need for a substance, that too can lead to depression. People mostly show signs of a low state of mood; they don’t enjoy things that brought them happiness earlier.
When our mental health is not all right, then it has a major affect on the daily life. It affects one’s physical wellbeing and results in changes in appetite. It brings out mood swings — one also tends to be neglectful of their surroundings, their home may come across as untidy, laundry could be lying around... One doesn’t have the same kind of energy and enthusiasm that they did before. Relationships, friendships change — one makes constant excuses to avoid meeting and often complains that they are too tired. They are often irritable, it affects their decision making, focus and concentration. There are various types of depression, such as substance abuse disorder, abuse disorder, seasonal affective disorder, postpartum depression and a whole lot of other forms that one needs to understand.
The depression statistics in India, as per a mental health survey conducted by NIMHAMS, indicate that 1 in 20 people suffer from depression, 1 in every 4 women, and 1 in every 10 men suffer from depression. Mental morbidity amongst a productive work force between 30-49 years is at 33 per cent. 150 million Indian need mental health care and only about 30 million are seeking this help. There is a severe shortage of professional health care workers in India — statistics show there are only 4,000 psychiatrists, 3,500 psychologists, 3,500 mental health social workers. 0.06 per cent of the health care budget in India is spent on mental health care.
Building a support system
People should be more mindful in their everyday life with their friends, family members so they can tell signs. One can notice people and see signs, like absence of eye contact or will, lack of motivation, no routine and could also have a dry mouth. Dark under eye circles could also mean lack of sleep. Statements like, ‘leave me alone’; ‘I will be fine’; ‘don’t worry’; ‘no one understands me and gets me’. It is important to have red flags, when one hears these kinds of statements, or witnesses such behaviour in a person. Sometimes, depression has a physical manifestation as well. A constant upset stomach can also mean depression or anxiety if someone is not keeping well and is stressed.
At such times, the role of family and friends becomes critical. Family members should increase communication and that can make a difference and help someone. A good listener can be helpful. Pay attention, connect with them. If someone withdraws, you need to understand their pain. Depression is a disease, not a taboo. Families can do activities together so that they feel loved, wanted. Socialising helps. Human beings are not designed to be alone. Lifestyle changes also help. A fast paced life can also have an effect on one’s mental health, this includes eating junk food and excessive drinking, etc. A lot of self-care and routine is important. Exercising helps as would maintaining a journal or even, picking up a hobby. This restores a sense of achievement and increases self-confidence and a sense of well being.
Despite showing signs of depression, it takes one around four to six years before they acknowledge and consult a specialist. A student commits suicide every hour in India, every three seconds there is an attempted suicide, which is a leading cause of death amongst young people in India. There is a deep rooted stigma and this prevents people from seeking help or sharing their story. If this is not caught on time and one does not seek an intervention — unfortunately, people don’t even understand the purview of this illness — it can have serious implications. There is stigma and shame attached to the word depression and this stems from the lack of understanding the ailment. People feel that if they suffer from mental health issues it could have an effect on their jobs, or someone will not get married, or they will not be accepted because they are different.
Domestic violence and mental health
Apart from depression, there are many other mental health issues which afflict our society. Domestic violence is a very serious cause of concern and we need to be more vocal about it and show that we are here to help and support. A lot of women suffer from depression because of the physical abuse that one goes through. If not checked, domestic violence keeps escalating. It needs to be addressed right at the beginning and nipped in the bud. The victim needs to speak up and if they don’t, the abuser in their mind justifies it and normalises the abuse. Have the courage to speak to someone and let them know that it has happened. Make a support group. The government has also shared a few numbers where one can reach out anonymously. One can also talk to their partner, or the person who is abusing, that this is not alright and see how one can work their way out.
As a clinical psychologist, I encourage people to speak up and not accept this behaviour. One can reach out to their mothers for guidance. Children learn what they see at home and children also pick up these signs. Abuse is not normal, it is the violation of a person’s fundamental right and should be addressed.
Family also needs to be supportive at times such as this and intervene. One must not be judgemental — that too can have a negative effect.
Mental health in the times of pandemic
Of course, mental health is a great concern especially in this time of great uncertainty. The Covid-19 pandemic has led to great displacement and isolation as people are caught in lockdown, as well as economic anxiety. People who have lost their jobs or have fears that they will lose their jobs should work on a plan B and look at increasing their skill sets and widening their options. They can look for other jobs and ask for help. It is absolutely alright to ask for help, and one should not be embarrassed about it, especially as this is a unique situation and has affected millions globally.
Reach out to friends, family and ask for help. It is only a matter of time. People should keep themselves busy. Reading, writing and learning new thing may prove to be helpful at this time.
One is bound to feel isolated and helpless, especially when one has to cut from social life, or work from home, but this is the time to ask for help and not stay quiet. If something is bothering you — you have anxiety, depression or other thoughts — they must be addressed. Online trolling can also lead to depression as can being on social media for an excessive amount of time, one can curb this and set a routine for themselves. Routines help immensely and can make one feel better and have more self-worth.
The first step in addressing this ailment is acknowledging it and understanding that you have a problem. As I mentioned, it takes about four to six years for one to address the issue, that is why it is important for others to look for signs and step in, and help, if they can. We need to make sure that it doesn’t result in suicide. National Crime Record Bureau stats reveal that there is an attempted suicide in India every three minutes and a student commits suicide every hour.
Mothers needs to bring up their children, and boys in particular, very mindfully and also teach them the value of respecting another individual and their life.
We need to make this a public health issue, have people speak about it and remove the stigma around this — we have done this for cancer, diabetes and even HIV. The right kind of awareness through conversation, dialogue and understanding of what depression is, would make mental health acceptable and people will open up and share their feelings, emotions and suffering. It is very important to speak about it through media and events. The government must also step in and do their bit and acknowledge that people suffer from an illness that needs to be addressed.
The writer is a clinical psychologist, four times gold medalist, who practices Logotherapy. She is a published author and has received multiple honours, including the 100 Women Achievers Award by the President of India
