“It started nearly a year ago. I would shut myself in the room and cry for hours together. I felt this strange urge to bang my head against the wall. Inflicting physical pain on myself was a way to get relief from the emotional pain.” This is how 26-year old Aarushi (name changed), a resident of Khar, who moved to Mumbai in 2014 for work, describes her recurrent episodes of depression.
“When I would start to feel better, there was revulsion, guilt and self-blame. In my struggle to find solace I have tried cutting my wrist at least thrice,” she adds.
Her parents, who live miles away in Ahmedabad, Gujarat, says she would cry frequently while speaking to them on the phone, but to them she only sounded homesick.
“She cried every day, but we blamed it on the long work hours and the fast life of Mumbai,” says her father, Paresh Shah (45), who admits he misunderstood his daughter’s emotional agony.
After nearly a year of this “abnormal living”, as Shah terms it, she sought help from a local physician, who directed her to a psychiatrist.
Shah is fortunate to have found a willing ear and medical treatment but many others, like 23-year old student Arjun Bharadwaj, who committed suicide earlier this week, aren’t as lucky. Arjun jumped off the 19th floor of a five-star hotel in Bandra while apparently intoxicated, after live-streaming a video of himself, which he termed a “suicide tutorial”, on Facebook.
He left several notes for friends and family, including one addressed to his mother that read: “Mom, this has happened because you never took my health problems seriously.”
Depression and anxiety-related disorders are most common of all mental health disorders, and affect women more than men, said doctors.
According to the World Health Organisation (WHO), more than five crore Indians – 4.5% of the population - suffers from depression while more than three crore – 3% of the population – suffers from anxiety disorders.
Mental health disorders are classified into two types. The first type includes major psychiatric disorders such as schizophrenia and bipolar disorders, which are largely genetic. The second category includes more common disorders such as depression and anxiety-related ones, says Dr Nimesh Desai, director of the Institute of Human Behaviour and Allied Sciences (IHBAS) in New Delhi.
“Unlike major psychiatric disorders, common mental disorders involve across both genetic and environmental factors. Depression caused by genetic factors does not vary much across cultures and socio-economic classes.
However, depression can also be triggered by socio-cultural and economic factors, such as the loss of a loved one, and stress at work and in relationships,” he said.
Stress of urban living
International studies have shown that depression is one-and-a-half times more prevalent in urban areas than rural areas, said Dr Desai. “The day-to-day stress of life, time pressure, work pressure, inter-personal relationships and pent-up frustrations all increase a person’s odds of having an episode of depression,” he said. Dr Dr Nilesh Shah, head of the psychiatry department at Lokmaniya Tilak Municipal General Hospital, Sion, said, “While some external causes are associated with depression, we still don’t understand the exact cause of it.”
Mumbai, with a population of 20 million people, has just 300 psychiatrists, according to data from the Bombay Psychiatry Association. This translates to one psychiatrist for roughly every 6.5 lakh people.
“It is clear that we do not have enough psychiatrists, cognitive therapists and counsellors, according to international standards,” said Dr Vihang Vahia, a psychiatrist at Lilavati Hospital, Bandra.
Dr Sagar Mundada, psychiatrist at KEM Hospital, Parel, that the situation is worse in smaller districts, where the primary healthcare is a shambles.
“Doctors there are simply not equipped to diagnose mental health disorders. This, coupled with poor awareness of psychiatric problems, leaves people with no choice but to approach faith healers,” he said.
Mental illness remains taboo
Doctors said that unlike other disorders while have easily discernible symptoms, people a reluctant to seek help for psychiatric illnesses. “The stigma associated with psychiatric disorders has reduced but still exists,” said Malay Dave, president of BPA.
“Compared to other metropolises, Mumbai has fairly good healthcare infrastructure, yet people choose not to seek help till their symptoms become severe,” he said. Devam Soni (27), a resident of Borivli whose father is yet to receive a diagnosis for his mental health condition, echoed this sentiment.
“For the past 18 years, my father has displayed severe signs of aggression. If my mother is five minutes late in calling him to dinner, he assaults and abuses her. For years, my mother refused to discuss his condition with anyone in our extended family but eventually they found out,” she said.
Her grandparents, she adds, blame her father’s condition on black magic. “They invested time in visiting temples and babas but none to visit a doctor,” she said.
Women and depression
Depression is two to three times more common among women than men, said Dr Shah. He said this may be partly due to levels of the hormone estrogen. “Estrogen levels drop during pre-menstruation and after delivery. It has been associated with low mood and irritability, which increase the odds of an episode of depression,” he said. Despite this, doctors, say, women, are reluctant to take medicine for psychiatric disorders, and more so after marriage. Dr Sanghanayak Meshram, a psychiatrist in Andheri, said at least two of his women patients who were on medication for schizophrenia committed suicide after they married.
“It is a common observation that women stop taking medicines after marriage in the fear that their husband or in-laws will find out about their condition. But then they have a relapse and have nowhere to go,” he said.