From Stigma to Courage: Redefining Mental Health Narratives
October 31, 2023
Fear has two meanings – forget everything and run or face everything and rise, said Zig Ziglar, an American author. However, when it comes to mental health, too many people feel they have no other option than to run and hide. It is synonymous with the abject fear of the unknown and the strange feelings it brings forth, making people wary of it.
When I was in school, my friend Jay excelled in academics, sports, and competitions. His winning streak showed no signs of waning as he continued to win laurels in college. He was always smiling, exuded confidence, and spoke well. Right after college, he landed an excellent job, making his family proud. It looked like he had it all. However, there was a part of him that was hidden as he had been repressing his sexuality for years.
As a teenager, he grew up hearing about the ‘evils’ of homosexuality, how it was abnormal, and how same-sex relationships were unnatural. He learnt that society saw it as a disease, and the shame and stigma associated with it were tantamount to a death sentence. As he grew up and started understanding his sexuality better, he feared that he would not be accepted by his family and friends. To mask these emotions, he maintained a hypermasculine persona and started spending long hours at the gym and office to divert himself. However, this façade was suffocating and took a toll on his mental and physical health. He feared the ramifications and spent sleepless nights, filled with anxiety, imagining various scenarios.
Jay’s story is not an isolated one. A report from 2017 stated that a whopping 197 million people in India were dealing with some form of mental illness.[i] This may translate to a loss of nearly $1.03 trillion between 2012 and 2030. However, the issue continues to be shrouded in ignorance, stigma, and shame. Unlike physical illness, mental health issues are often shrugged off as a mild case of the blues. This can have devastating consequences in a country like India where the population is predominantly young. Here are some of the reasons why mental health problems are a growing epidemic:
- Lack of Awareness: There is a lack of education about mental health in schools and communities. Many people are not aware of the signs and symptoms of mental illnesses, leading to a lack of understanding and empathy. Moreover, the degree of knowledge about the issue varies with cities faring slightly better than smaller towns and villages.
- Skewed Doctor-Patient Ratio: India has a population of 1.428 billion people. However, there are only 0.75 psychiatrists per 100,000 people, which is a far cry from six psychiatrists per 100,000 people in higher-income countries.[ii]
- Cultural Expectations and Conditioning: In several households, statements like ‘boys don’t cry,’ ‘don’t fight like a girl,’ and ‘girls must be seen and not heard’ are common. These deeply rooted cultural norms and societal conditioning continue to contribute significantly to the prevalence and exacerbation of mental health issues. Moreover, culture places a strong emphasis on collectivism and familial bonds. While this can be a source of emotional support, it may also discourage individuals from expressing their feelings openly.
- Stigma: The distress of ‘what people will say’ has made it hard for individuals to speak to their family members and seek help. For many, the fear of judgement and lack of empathy makes them reluctant to have open conversations about their struggles. Moreover, some also tend to blame themselves for their predicament. In rural pockets, these issues are still associated with myths and superstitions. Therefore, the afflicted individuals are taken to faith healers and quacks for a cure.
- Gender-Based Differences: Women are far more prone to mental health issues such as depression and anxiety as compared to men.[iii] Internalization of trauma, domestic and sexual violence, socioeconomic conditions, reproductive health, the pressures of balancing work and home, and familial pressures put them at a higher risk.
Overcoming the obstacles
Seeking mental health treatment can be challenging due to various obstacles. Overcoming them requires societal, governmental, and individual efforts. Here are some strategies that can help:
- Spreading Awareness: Without awareness or knowledge about mental health problems, the number of those afflicted will only grow. Awareness needs to begin from the grassroots level, from families speaking about it to governments empowering people to act. Community-based activities such as awareness camps, free psychiatric check-ups, and therapy are important steps to promote mental health literacy. The government can work towards making mental health a priority to further spread the message. NGOs can collaborate with the government to reach marginalized communities to provide mental health services and support. They can further join hands with international organizations to access resources, expertise, and best practices in the field of mental health. Docfluencers specializing in mental health can also leverage social media platforms to disseminate authentic information, dispel myths, and encourage seeking help.
- Improving Infrastructure and Access: The infrastructure in the country to deal with mental health issues is inadequate, with just 329 outpatient services per 100,000 people.[iv] The current infrastructure needs a facelift and must be expanded to cater to a larger population. Higher budgetary allocation can help fill the gaps that hinder the administration of treatment. Moreover, mental health should be a part of the universal health coverage plan. Further, technology has been able to bridge the gap between patients and professionals. Health apps make consultations easier, more convenient, and discreet.
- Training More Psychiatrists: Budding doctors tend to pursue more competitive and lucrative specializations such as radiology, dermatology, or paediatrics after they graduate. There are just 1,360 seats for psychiatry in India, which is inadequate to deal with the growing number of patients. Hence, increasing the number of seats can help improve the doctor-patient ratio.
- Role of Healthcare Communicators: At a time when misinformation is prevalent across channels, healthcare communicators play a vital role by providing genuine, crucial, and nuanced information to patients to understand their condition and seek professional help. They also help break down barriers and create a supportive environment for mental health patients. They need to be culturally sensitive and aware of the diverse needs of various communities. Different cultures may have unique perspectives on mental health, and effective communication strategies should be tailored to respect these differences. Their efforts contribute significantly to a society where mental health is understood, accepted, and appropriately supported.
Though the mental health crisis looms large, India is taking baby steps towards improving the situation. A renewed push is necessary among citizens, irrespective of their socioeconomic conditions, sex, caste, religion, and sexual orientation. Fostering a nurturing and nuanced mental health ecosystem that encourages individuals to reach out fearlessly will be the first step toward healing. Rather than fearing mental health problems, individuals should face them courageously with a positive approach that can lead to growth, resilience, and overall well-being.
[i] Dhyani A, Gaidhane A, Choudhari SG, Dave S, Choudhary S. Strengthening Response Toward Promoting Mental Health in India: A Narrative Review. Cureus. 2022;14(10):e30435. Published 2022 Oct 18. doi:10.7759/cureus.30435
[ii] Garg K, Kumar CN, Chandra PS. Number of psychiatrists in India: Baby steps forward, but a long way to go. Indian J Psychiatry. 2019;61(1):104-105. doi:10.4103/psychiatry.IndianJPsychiatry_7_18
[iii] Albert PR. Why is depression more prevalent in women?. J Psychiatry Neurosci. 2015;40(4):219-221. doi:10.1503/jpn.150205
[iv] Dhyani A, Gaidhane A, Choudhari SG, Dave S, Choudhary S. Strengthening Response Toward Promoting Mental Health in India: A Narrative Review. Cureus. 2022;14(10):e30435. Published 2022 Oct 18. doi:10.7759/cureus.30435