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It?s all in the Mind

What are the inner conflicts afflicting the mental health sector in India?

india Updated: Mar 19, 2006 01:44 IST

"We believe that the state of psychology in India is none too flattering. In fact, we find psychology in India unable to play its necessary role in our national development. It is widely believed that this unfortunate state of affairs is largely due to the fact that psychology in India is essentially a Western transplant, unable to connect with the Indian ethos and concurrent community conditions… lacking in originality and unable to cover or break any new ground."

National Conference on Indian Approach to Psychology, Pondicherry, September-October, 2002.

Three and a half years on, in India, Dr Shrink’s appointment diary has seen an exponential growth of scribbles and scrawls. Urban Indians, traditionally known for their “closed minds”, are suddenly letting it all hang out while they try to get comfortable on the couch. The shrink sector (psychologists, psychiatrists, psychotherapists et al) is on a roll, clocking an estimated 80 per cent growth rate — in appointments/revenues terms.

So, is India in the pink of mental health?

Not really. Suicide rates have hit an all-time high. South India has been dubbed the ‘World Suicide Capital’ (32 people kill themselves in Kerala every day); the Capital itself recently witnessed a spate of suicides by students (and last year, an NGO, Sahyog, claimed that 57 per cent of students in New Delhi were “depressed”, and 9 per cent “suicidal”); in Mumbai, glamorous and well-paid actresses/models have regularly been killing themselves.

And what are our psychologists and psychiatrists doing about it? Quite clearly, not much.

Kavita, a Delhi-based primary schoolteacher, has been undergoing psychotherapy for the last one-and-a-half years. She claims that she was feeling depressed for the last five years. “I went to a psychiatrist who asked me details about my sleep patterns and the way I felt when I woke up.” After a series of tests, she was put on medication. “Initially it seemed to work, but then I got dependent on the drug, and I started feeling miserable without it.”

Then, she tried to look for a counsellor, and went to the same government hospital where she’d consulted the psychiatrist: “But to my horror, I discovered that the government hospital had no proper psychological counselling cell. I cannot afford to spend Rs 1,000 per session with some private therapist. Who can I talk to?”

The dangling conversation

Even those who can afford to talk to shrinks may have a problem. Many feel that Indian shrinks are not taught how to talk to patients. Dr Rajat Mitra of Delhi’s Swanchetan, says, “Even those who have done their Master’s in clinical psychology have little or no clinical experience”. Mumbai-based psychiatrist Dr Anjali Chabria agrees. “There are several people who think that being a good listener and advice-giver is the same as being a qualified psychologist.” There are those who have “liked” psychology in school, who take short-term courses and become lay counsellors. “This is dangerous because people with clinical problems will not be diagnosed and given treatment.”

Another Delhi-based mental health specialist points out that our psychologists and psychiatrists are given “very little or no training in psychotherapy”. “A large number of psychologists essentially give grandmother’s advice. An MPhil in Clinical Psychology from Delhi University, for instance, doesn’t equip you to become a therapist.”

And here’s more reason to be more alarmed: Dr Chabria says there are about 50 to 100 of “sham operators” for every qualified psychologist.

The number game

And even as more and more Indians are getting on with the couch treatment, the sector is still numerically unfit: it is estimated that India has around 3,500 qualified mental health professional (psychologists and psychiatrists). More than 60 million Indians are reported to have psychological disorder. On a rough calculation, that would mean 3 doctors for one million patients. Dr Mitra says that the required number should be “at least be five to six times more”.

Off limits

There are many areas in the realm of mental health that still have not been trodden. “In India, the family is supposed to be the support system, and usually people turn to those within the fold in times of need,” says sexologist Dr Prakash Kothari. Cases like child abuse and marital rape — extremely common in India — are taboo within the family, and therefore ignored. “An area like sexual counselling is almost non-existent, and people are still to get comfortable with the notion.” Not surprisingly, a lot of quacks abound and serious medication/counselling is given a go-by.

‘I know best’

Then, there’s the “very Indian” concept of self-medication. “People hear that Prozac might make them happier and they go looking for the drug at the nearest pharmacy,” says Dr Aruna Broota, who is professor of Psychology at Delhi University and a trained clinical psychologist. “If you happen to have a personal rapport with the pharmacist [which is pretty often the case], he will give you the drug without a prescription.”

No child’s play

Finally, there are cases where a disorder is manipulated – in order attract attention. And, often in the case of children, these are “manipulated” by parents/family. “These days, in certain quarters, it’s almost fashionable to send your child to a therapist – when all they need is simple guidance,” says Hemant Kumar of Kaberi, an NGO that works on sensitisation to children’s needs. He feels that “one in 100” kids may have serious disorders — but basically, “every child’s potential is the same”. What is required, he adds, are “efforts to create an interest in things that children seem averse to, instead of telling them that there’s something wrong with them, and packing them off to a doctor”.

Drs Amit and Shelja Sen, child psychiatrist and clinical psychologist at Sitaram Bhartia, say that as a nation, “we do not want to admit that their [children’s] coping abilities are not very well-developed as yet. Throw them in the pressure cooker, block the safety valves and if there are any casualties, too bad!”

Shaking our heads, we can always blame it on how today’s youth want to take an easy way out.

With Neha Mehta, Shreevatsa Nevatia, Mayank Tewai/New Delhi and Rachel Lopez/Mumbai.