‘Look at these pictures, he’s smiling, playing with his dog, there is no sign of depression on his face…’
‘He was an extremely , may have gotten upset but he was not depressed, depression is a big thing…’
These two remarks—made on national mainstream news channels as part of the on-going lurid coverage of actor Sushant Singh Rajput’s tragic death on June 14—epitomise the very real stigma around depression (or any other mental disorder) in this country.
Do bright people not get depressed, does it only afflict the stupid, does depression have some special visible symptom—perhaps a haggard face with teary eyes, a dejected expression, horns on the head?
Such legitimising of ill-informed, archaic notions of what a depressed person looks like, how he/she behaves and functions, emphasise the pressing need for a lot more conversations on mental health, especially in these dystopian Covid-19 times.
So what kind of creature is this person with depression (diagnosed or otherwise)?
He could be much like you and me, a functioning professional—talking, working, playing, even partying—yet battling an illness that has taken root inside him, chipping away at the core of his happiness.
What he is also battling behind the smiling face and work-filled days is the isolation that is a part of this disease, the unsaid belief that he alone has to ‘get over it’, that it is his fault somehow because strong people do not get depressed, they deal with their problems!
This widely-held perception that depression is a less serious disease than say cancer or heart ailments and that the patient has somehow brought it on himself and now bears the onus of recovery, is what needs to be countered on a daily basis if need be. Because: You cannot ‘snap out of it’, you cannot ‘get going’, you cannot ‘be positive’, all on your own.
What you can do is reach out for help.
Family and friends are the ‘first respondents’ as the phrase goes but the misconceptions about depression (or any mental disorder) are so strong and denial so ingrained, that ill-timed advice and admonitions are the more likely first response.
When you cannot seem to get out of bed every morning and feel life is not worth living — for a sustained duration of time — the appropriate response cannot be a list of ‘shoulds’. Should exercise, should venture out, should work harder, should quit binge eating…would anyone give such advice to a cancer patient? Or to someone who has fractured his leg — ‘c’mon, get up, don’t lie around taking an off day…’
Empathy is the only ‘should’ — to be displayed by the immediate familial circle, with no judgment, no assumptions, no conclusions. But since people are often uncomfortable with or ignorant about the magnitude and manifestation of this disease — sadness or grief is not depression — there are six magic words they can use: What can I do to help?
From spotting red flags to researching the actual dialogues one can have with patients of depressive disorders — the internet has plenty of educated choices, what to say, what not to say, when to intervene, when to simply be there. Make a template with the key words of reassurance and love, internalise them even if they seem like alien concepts, use the phrases often — a depressed person needs the affirmation, needs the words, needs the love more than you know.
The Covid pandemic and its prescribed limitations and lockdowns have eliminated a huge source of comfort giving and taking — physical affection — with only virtual hugs now being given to alleviate the crushing sense of seclusion that is the hallmark of such disorders.
These are anxious, abnormal times for everyone but for people struggling with the all pervasive depressive thoughts, the fears escalate to alarming degrees and frequency — every single worry is amplified a hundred-fold. And when quick fix options (offered online or on social media) such as meditation or breath watching or yoga are simply not enough, the safest way out is the professional help route.
The prohibitive costs of therapy however — both medication and counselling — makes it accessible to only the privileged few who ask for it. The National Mental Health Survey report of 2015-16 estimated that although 150 million Indians need mental health intervention, less than 30 million are actually seeking care.
With the being less than one per cent of India’s annual total health budget, the professional resources available are appallingly inadequate. The Indian Journal of Psychiatry (April 2019) listed approximately 9,000 psychiatrists, 1000 clinical psychologists, 2000 mental health nurses and 1000 psychiatric social workers to tackle 13 crore people suffering from diagnosable psychiatric conditions and one crore with severe mental disorders.
A single session with a psychiatrist or counsellor can vary between Rs 500-5,000, multiple sessions are often needed for diagnosis and treatment. Unlike the familiarity of going to a specialist for ailments such as hypertension or diabetes, a visit to a mental health professional is fraught with in-built stigma — what if people find out, what if the treatment doesn’t work, what if the therapist doesn’t keep the sessions confidential? The unfortunate recent by a therapist of Sushant Singh Rajput’s mental disorder on a public media platform will doubtless deter many people from reaching out for professional help.
Efforts to fill the vast gap between mental health needs and affordable resources include more recent options such as iCall helplines and NGOs such as Alternative story. But in an ecosystem where mental disorders and patients suffering from them continue to be pilloried and shamed, what you really need is to bring it out into the open and start talking (about mental health) — with friends, colleagues, young students and senior citizens, in colleges and offices, in public spaces and private homes. Regular, formal or informal, intimate or shared conversations, across all fora, breaking the anonymity barrier ‘protecting’ your identity thus far. You’d be surprised at how many of your friends and acquaintances inhabit the same echo chambers, especially on social media. Not just those whose gratuitous posts regularly remind you that their homes and their coffee are always available on tap but those who continue to battle — and cope — with crippling depression on a daily basis.
Survivors sharing their personal stories are in fact the best ambassadors for spreading awareness and empathy. Their tales of enduring and emerging victorious on the other side are far more likely to strike a chord amongst millions facing similar demons and dilemmas. Talk about the ‘nightie days’ when you don’t even brush your teeth and watch OTT shows all day. Share posts about how imagining all the people attending your funeral made you feel immensely better in a past suicidal phase, bring the ugly out in public, it immediately loses half its potency and power. It is the silence and the loneliness that is the real enemy.
Once it has ‘come out’ of its strait-jacketed chamber, depression will no longer be seen as a Hydra-headed monster but an illness you can deal with, even befriend, as you learn to navigate its troughs and valleys.
It may be too late for those who have crossed over to the other side in a vulnerable, not weak, moment; Sushant Singh Rajput may or may not have been one of them. But it is never too late to send out and repeat the message that all mental health patients need to hear every single day.
‘You are not alone, you are not unloved, you can reach out for help. This too shall pass.’
If you, or someone you know, needs help to overcome suicidal thoughts, contact: Fortis: +91 8376804102; AASRA: +91 98204 66726; The Samaritans, Mumbai: +91 84229 84528 (5 pm to 8 pm)