THE MOST PRESSING ISSUE FOR THOSE SUFFERING MENTAL HEALTH DISORDERS IS STIGMA.
The floods brought Mumbai to a standstill in July 2005.
Mumbai’s Sir JJ Hospital saw a sharp rise in admissions, but the patients being admitted to the wards weren’t necessarily coming in with flood-related ailments, but with complaints of all sorts.
Situated in the Byculla area of South Mumbai, Sir JJ Hospital is one of the city’s most prominent government hospitals, and a large number of patients flock through its doors for treatment every day. Diversity in the cases they see is to be expected. But on one particular day that July, the hospital staff were flummoxed when a man was admitted in an…unusual state. Sitting on his haunches, unflinching, he refused to speak or move. Around 5’10”, even though he wasn’t standing, he appeared to be 30-something, dishevelled, and with an overgrown beard and drool covering his face.
Dr Kiran Shandilya was a resident in the hospital then. The lady who brought him in insisted that she wasn’t related to him and was just trying to help. Another man showed up, claiming to be the patient’s brother.
“Sadma ho gaya hai.” (He’s in shock.)
“Biwi, bachhe kho gaye flood mein.” (He’s lost his wife and kids in the floods.)
After some deliberation, Dr Shandilya decided to shift the man to the psychiatric department, diagnosing a classic case of catatonia. Catatonia is a type of schizophrenia, a state of unresponsiveness to external stimuli. No matter what happens, the person (who is awake throughout) is unresponsive to everything around him.
Catatonia, coupled with several other mental disorders such as bipolar mood disorder and depression, remains largely misunderstood even in contemporary Indian medical practice. Dr Smitha Vatwani, a psychiatrist we spoke with, cited cultural complexities, such as the influence of god-men and ‘babas’, as part of the problem. With conditions often misdiagnosed, people flock to promises of miracle cures, blindly trusting them to do away with the bad karma causing the mental disturbance, whatever it might be. The practice of looking first to black magic as an explanation for mental disorders is much more common in rural areas, Vatwani said, in places where illiteracy is rampant and a lack of awareness about mental illnesses is hard to overcome.
People hesitate to approach doctors with mental health troubles, Shandilya said. If you’re in a room full of people, it’s ok for you to scowl and say that you have a headache. It is, however, not okay to stand up and say that you’re sad. You’re considered ‘weak’. Shandilya continued, if there’s a local train compartment with 50 people in it, at least 10 of them have depression.
Another doctor, a general physicial named Dilip Desai, shared that he often tells patients to give it a shot, and if the patient doesn’t improve, to then approach a medical professional for treatment. But the medical professional is the last resort. “I cannot change it,” Desai said, referring to the beliefs of those who approach him. He prefers to steer clear of disparaging the beliefs of his patients, and lets the patients’ families learn on their own, only being firm in instances where the patient is serious and needs immediate medical help.
Back at Sir JJ Hospital, as Shandilya tended to the mystery patient, she decided he needed a good bath and a shave. That suggestion was vehemently shot down by another member of the hospital staff, who pointed out that the patient had a Muslim name, implying that removing his facial hair would be a breach of religious sentiments. Amidst this commotion, the brother vanished from sight. Shandilya persevered, and had her patient cleaned up. With a little digging and some intervention by the police, it came to light that the man was from Nepal, a teacher with a daughter. The “brother” was, in actual fact, an impersonator hoping to make a quick buck for his drug addiction. He nicked money from the man’s pockets when no one was looking. The patient wasn’t Muslim, and the lady who had helped bring him in was a nurse, a Good Samaritan.
In the records made public by The National Commission on Macroeconomics and Health in 2005, between 10-12 million people suffer from severe mental disorders such as schizophrenia in India, and almost 50 million suffer from the more prevalent disorders such as anxiety and depression. One decade later, mental health statistics remain a grim proposition in a society that shies away from broaching the topic of mental illnesses in polite company.
Dr Bharat Shah, a professor of psychiatry at Somaiya Medical Hospital and a consultant at several hospitals in Mumbai, wrote in a piece for a local city hospital newsletter, “People, who require help and can be helped, continue to remain behind closed doors. They continue to suffer in silence, alone.”
I visited the psychiatric out patient department at KJ Somaiya Hospital on a blisteringly hot Tuesday afternoon. Divided into a number of small rooms, and filled with that unmistakable hospital smell of disinfectant and dread, portraits of goddesses were on the wall, next to a ticking clock and shelves filled with labelled boxes:
Psychotic and emergency injection.
There was a steady hum of conversation that wove in and out of focus. I met one of Shah’s patients and her husband, who spoke to me on the condition of anonymity. He was a young man in his late twenties, unshaven, with deep-set eyes and a chequered shirt. He required only a little probing and a few questions before he told me his story in a matter-of-fact tone. A few years ago his wife fell ill repeatedly, and no one could explain why. Shuffling between various cities in India in search of a diagnosis proved fruitless. He described his situation in a few lines, “Kahin bhi baithe, dil nahi lagta.” No matter what we chose to do, our hearts weren’t in it.
His wife was diagnosed with schizophrenia when they met Shah at Bandra’s Lilavati Hospital. She said that before her treatment she had violent episodes and remembered nothing of them. A regular dosage of the right medication, counselling sessions and regular follow-up visits changed everything. The couple now have 18 month-old twins. According to Dr Shandilya, while every case is different in terms of complexity and severity, proper diagnosis, treatment and familial support are tried and true combatants of most psychiatric disorders.
Every doctor we spoke with agreed on one thing: there are a staggering number of patients, and not enough doctors to treat them. Allegations of mistreatment in the psych wards of hospitals across the country abound, and the doctors agreed that things can, and do, go awry. The gaping chasm between the number of medical personnel required, and the number actually on-hand makes it incredibly difficult to fairly monitor patients, and much less look after them with empathy. And sometimes the psych ward is the first casualty. Vatwani pointed out that Bhagwati Hospital in Mumbai’s Borivili area, currently closed for renovation, doesn’t even have a psychiatric ward.
If the stigma that surrounds mental illness in India is bad to begin with, misrepresentation in popular culture pushes it right over the edge. A common example is the gory depiction of electro-shock therapy in Indian cinema. All the doctors we spoke with opined that it is an extremely effective treatment option with ‘literally no side-effects.’ Drugs, they said, on the other hand, often have side-effects such as weight gain and overdependence. “But I would use it sparingly,” Vatwani said. Both Vatwani and Dr Dilip Joshi, another general physician, said that one of the most wide-spread concerns involves concealing these conditions from prospective spouses. Spousal abandonment after having discovered the deception is also a recurring theme.
The landscape of mental illness is vast, untraversed, and peppered with al sorts of disorders, from those relating to eating, anxiety, mood, and compulsive behaviours to schizophrenia, dementia … and those are only the well-documented ones. The deep recesses of our minds hold profound mysteries. The World Health Organisation predicts that almost 20 percent of India’s population will suffer from some kind of mental illness by 2020. We’ll be losing our minds a lot more in the future, the same way we’re losing our bodies.