More people are willing to approach a mental health professional because some of the stigma is fading. This is more pronounced in the upper middle classes and the middle classes but it is also true among the poor as well.(Arun Sharma / HT Photo)
More people are willing to approach a mental health professional because some of the stigma is fading. This is more pronounced in the upper middle classes and the middle classes but it is also true among the poor as well.(Arun Sharma / HT Photo)

When things get too much to handle, don’t shy away from a therapy couch

Will you get medical help if you have fever or your tonsils are swollen? Sure. But what if you’re not in the best of mental health? The good news: Indians are no longer fighting shy of going on the couch.
Hindustan Times | By Jerry Pinto
UPDATED ON AUG 21, 2016 09:48 AM IST

“When I was pregnant with my third child, my first was two-and-a-half,” says Aliya who requested that her name be changed. (“Not because I have anything against being identified, but I don’t want my children thought of this way.”) An artist by profession, her career is on hold. “I know. What was I thinking? Let’s just say I’m not an advertisement for planned parenthood.”

And so baby Rohan at two months is at Aliya’s breast, baby Nayantara at one-and-a-half is toddling around and Tahira at two-and-a-half has issues.

“When Nayantara came along, things were fine for the first six months, at least with Tahira. But then the baby begins to become a presence and Nayantara began moving quickly, taking up Tahira’s space, shifting attention from her,” Aliya remembers. That’s when Tahira began pushing her baby sister over, hurting her in small ways, until her mother decided to seek help.

“First, I asked other parents about it and they all said it was normal. My own mother told me that me and my sister had fought when we were children. I asked my aunt who was headmistress of a playschool and she said it was nothing to worry about. But then I got pregnant with my third, and I was asked to be very careful. And Tahira found that her mother, who had done so much with her, taken her out, had fun, romped and played, was suddenly unavailable. This was the height of summer and we were cooped up at home, Me, Tahira nearing the terrible twos, and Nayantara. I had read all about this, I knew it was jealousy, and I knew that I was not supposed to shout at Tahira. I was supposed to explain things to her, gently, caringly, not to increase the amount of violence in the air.”

But Aliya began to wonder whether things were getting out of hand. “I could see, during that time, that Nayantara’s gentle nature was changing. She was fighting back. She was getting aggressive. And when I took her to a toddler group, she began to demonstrate the same behaviour as her sister.”

That was when Aliya reached for the telephone and called a psychological counsellor.

Read | India’s new mental Healthcare Act

A middle-class Indian reaching for the telephone and asking for medical help? If you had a fever, sure. If your tonsils were swollen or your skin was erupting, of course. Because you weren’t sure whether you were in the best of mental health? That was a stretch. But it does seem to have become a lot more common now.

“But it’s only a very small percentage,” says Dr Prakriti Poddar, a hypnotherapist who practises in Mumbai. “Many of my clients come from the very rich and they won’t even sit in the waiting room if they’re a little early. They prefer to wait in their cars.”

If it is true that one in four of us will deal with a mental health issue as we go through our lives, why are we still waiting in cars?

“it’s the stigma,” says Poddar. “It’s real for most people.”

Everyone should go into therapy at least once in their life. However, therapy is expensive and that forms a natural barrier between most people and an analyst’s couch. (Getty Images)
Everyone should go into therapy at least once in their life. However, therapy is expensive and that forms a natural barrier between most people and an analyst’s couch. (Getty Images)

Dr Sunay Pradhan, consultant psychiatrist at the Masina and Saifee Hospitals in Mumbai feels however that the stigma is beginning to abate. “More people are willing to approach a mental health professional because some of the stigma is fading. This is more pronounced in the upper middle classes and the middle classes but it is also true among the poor as well. I see many of these patients and the effect of electronic media has meant that they are willing to see a mental health problem as something that can be helped in a hospital.”

While many people see Deepika Padukone’s confessions about her struggle with depression as a milestone, it is safe to say that if you’re in a creative profession, you’re allowed much more leeway than if you’re an investment banker.

The painter Lalitha Lajmi, now 84 years old was 32 years old when she went into therapy with psychotherapist Udayan Patel. Her brother, the noted filmmaker Guru Dutt, had committed suicide and the artist herself had domestic difficulties. “I found it difficult to accept. He died so young and so suddenly.”

But it wasn’t easy, the process of opening up. “For days, I would just go there and weep. And even when I stopped, I found it difficult to find the words that I wanted, that I needed, to express what was going on. When at last I began to speak, I found that I began to dream as well, disturbing dreams, good dreams. Analysis was often difficult. It was so important to go deep and so scary to do that. But I kept at it for five years and the result was an extraordinarily creative period. I was working on etchings, paintings, a series called Dream series. To my own surprise, poetry followed, poems I wanted to show to other people.”

This is the central problem. Healing isn’t supposed to be scary. It’s supposed to be comforting. You’re supposed to be in good hands with a doctor. But what if the hands you’re in are your own? What if those hands are not willing to help, but only want to pretend to help.

“For many of my clients,” says a therapist in South Mumbai who requested anonymity, “I think I am a bit of street cred. I make them interesting. They can say, ‘As my therapist said...’ and they can signal to someone else that they’re interesting.” Dr Prakriti Poddar calls it “Recreational therapy or therapy as recreation.”

I don’t think that was why I went into therapy myself, to be interesting or as recreation, one more thing to do of a morning; but I can understand how often one can do it for the wrong reasons. Mine were simple. I wanted someone to tell me I was okay, that I wasn’t going to end up with electrodes attached to either side of my head. I knew, of course, at some intellectual level, that no one is normal, that we’re all oddly-shaped, that we’ve all got issues. I said this to other people but I did not believe it about myself. I was different, I thought in my hubris; I would achieve the impossible: the completely creative, totally psychologically normal existence.

And so for a year in very expensive therapy, I tap-danced with my doctor. I told him ‘everything’ which meant everything I thought he should know. I saw myself as extraordinarily candid, free-flowing, but one day, halfway through a story, I realised I had fallen into an old pattern: I was trying to amuse my therapist. I wanted him to laugh at the right moment, I wanted him to enjoy our sessions and I wanted him to think well of me, not to see me as one of those terrible needy patients, but a smart sensitive man in charge of his own destiny and completely aware of his own turmoils, a somewhat amused witness to the grand guignol of his internal life.

Putting down that mask was one of the hardest things I did. Even recognising this person, this act, was a moment of searing truth.

Read: Voices in their heads - How India deals with mental illness

So the road to mental wellness is a well-lit path through a green wood. “When couples come in for counselling,” says Poddar, “they want you to say who’s right and who’s wrong. And it seems very obvious that man and woman go away with what they want to hear. Then what you say will be used as weapons against you.”

This was one of the most frustrating things about therapy, I found: the silence on the other side. There were times when I felt like I was drowning in contradictory selves but my therapist watched calmly. I knew, of course, that I was there to craft my own answers and that any interventions he made would be counterproductive. But that didn’t prevent me from getting exasperated.

“I’m not waving but drowning,” I said.

“As long as you can quote Stevie Smith, you’re still waving,” he said.

I could have hit him. I didn’t.

Did Tahira stop hitting Nayantara?

“No,” says Aliya with the kind of grim resignation you only see in the mother of three under three. “But I now can see that I called because I wanted something to do, I wanted to feel I was handling the situation by doing something. I did speak to her, she did say all the right things, I did feel better. But at some level, what psychologists deal with is an image of the child, a formulation that they have come up with after looking at many children going through these crises. She wasn’t going to be able to deal with Tahira. I was going to have to. And once Rohan was born and I was freed from the captivity of bed-rest, I began to see that I was going to have devise my way through this. I was going to be the person on the spot, the person to decide whether it was going to be the ‘Didn’t we talk about this?’ or ‘The naughty chair for you’ or even some negative reinforcement. My call. I have to make it. I’m glad I talked to her but I am not going to cede control to her.”

Do you need help?

“Everyone should go into therapy at least once in their life,” Mehlli Gobhai, a painter who had one successful and one not-very-successful stint at analysis, once said to me. And many people would agree. However, therapy is expensive and that forms a natural barrier between most people and an analyst’s couch.

Is it for you? The answer is simple: if you think your moods, your attitudes, your responses are interfering with your enjoyment of life, perhaps you should seek help. You could start with a counsellor, and some issues which are circumstantial — dealing with the end of a relationship, with a bad time at work — can be treated right there, simply by having someone who will listen to you.

But if you are unable to function as you would like to, if you are contemplating suicide, if the things that normally make you happy — a good meal, a night out with friends, a splash out at the bookstore — leave you untouched, perhaps you need to meet a psychiatrist. They are the ones who can prescribe psychiatric medication. Other danger signals: you’re entering into a strange relationship with food; your mood swings have you at their mercy; you’re abusing drugs or alcohol; your fears are paralysing you; you’re beginning to think ‘magically’.

As for analysis or therapy, that can be used in conjunction with psychiatric medication and then as a way through and to a better relationship with yourself and the world.

Finding the therapist that suits you

1.Don’t go with the first name that Google throws up. This is about your life and your mental well-being.

2.Do some research. If you have friends who have been in therapy, ask them for recommendations. But make sure it’s simpatico friends, people who resemble you in the ways that matter.

3.You don’t have to like your therapist. (In some schools of thought, you have to fall in love with your therapist—it’s called transference—and only then can the change begin but never mind that). You do have to feel comfortable with her or him. Don’t be afraid to cut and run if someone who you researched and who was recommended makes you feel strange.

4.Don’t discount cultural factors. “My mother says she was plagued by guilt about the birth control she was using,” says a Roman Catholic friend. “Her Parsi therapist just didn’t get it. It took a Christian to understand, to help her work out her problems and to release her from them.”

5.Your friend is a therapist. You think: this might work, she already knows me and she understands. Chances are, your friend will tell you kindly but firmly that it isn’t possible for her to be your therapist. Because you need someone who is objective and friendship doesn’t make for objectivity. But you can use a friend who is a mental health professional for referrals.

Making therapy work for you

1.You have to want to get better. This may seem easy. But your condition may become a matter of routine; it may seem comforting and comfortable. Or you may not even know that you’re working to keep yourself in the same place.

2.You have to be honest. You have to be able to completely trust your mental health professional which means you have to be sure about her or him.

3.You have to hang in there. This is probably not going to work if you give yourself two weeks or two months to deal with it.

4.You have to accept unpalatable truths about yourself. “In therapy,” says Dr Poddar, “there is no such thing as an accident. You stub your toe because you want to punish yourself in some way. But it’s difficult to get people to see that.”

5.Make sure the therapist knows your family history. Make sure you know your family history. The social stigma attached to mental illness means that many families simply won’t talk about these things.

Jerry Pinto is an award-winning writer and essayist. His latest book is A Book of Light - When a Loved One has a Different Mind. He has also written Em and the Big Hoom .

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